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Digitized by the Internet Archive 

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CARL!: Consortium of Academic and Research Libraries in Illinois 



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INDEX VOL. S. 

Abstract of the Gross Auatomy of the Abdominal Part of 

the Alimentary Canal, W. T. Eckley, M. C 329 

A Clinical Report of four cases of Abdominal Section by S. 

H. Champlin, M. D 164 

A Clinical Report (a) Transverse Myelitis (b) Hemorrhage 

into the Cervical Cord, A. W. Dunning, M. D 28(> 

A case of Eczema, W. M. Belitz, M. D 244 

A Good Location , 17 

Alpha Epsilon Iota 434 

Alpha Kappa Kappa 431 

Alumni Notes.. ..34-66-113-143-177-226-272-317-265-299-355-422 

Announcement 327 

An Open Letter, D. A. K. Steele,M. D 113 

A Rapid Method of Paraffin Embedding, S. H. Champlin, 

M. D 64 

Are Country Doctors Hard Thinkers? E. C. Suefert M. D 238 

Athletics 182-230-274-315 

After Treatment of Fractures and Dislocations, D. N. Eisen- 

drath, M. D 291 

Cardiac and Bronchial Asthma, A. C. Crofton M. D 296 

Cannabis Indica Poisoning. J. C. O'Day, M. D 323 

Clinic Before Class of Chicago Clinical School, John B. Mur- 
phy M. D 77 

City Song, George Richards Parr 266 

Class Calendar — By O. B . Dunham 425 

Class Day Address 416 

Class History— By H. B. Hamilton 397 

Clinical Department 71-219-267-310-260-298-351 

Clinical LaboratoryW. Coates, M. D. 69-103-173-199-259-313-252 
Collateral Blood Circulation and Pneumatic Treatment, Ar- 
thur F. Kleintop, M. D 349 

Dr. Albert Edward Hoadley 266 

Editorials 13-50-90-119-158-203-243-305-247-295-345-364 

Entertainments and Social Events — By R. G. Gale 423 



5552.^ 



Tlic Plexus. 

Epidermization Clinically considered, Walter VanHook A. B. 

M. D 56 

Evolution of Mind, Albert Schneider, Ph. D., M. D 99 

Frau Gehli, E. F. Snydacker, M. D 241 

Freshmen Notes 224-280-326-272-306-359 

History— The College of Physicians— By D. A. K. Steele, 

M. D 378 

Hot Weather Care of Infants and Young Children, F. W. 

Reilly, M. D 107 

Hurrah for us 98 

Junior Notes 222-277-323-270-304-356 

Large Uterine Fibroid Accompanied by Pregnancy, J. B. 

Eagleson, M. D 128 

Letter from Prof. H. P. Newman 215 

Library Notes 39-73-115-175-225-269-319-267-301 

Lights and Shades in the Doctor's Career, F. B. Earle M. D. 147 

Medical Ophthalmoscopy, W. E. Gamble B. S., M. D 85 

Method of using Protargol in Gonorrhoea, J. Stephen Nagel 

Ph. G., M. D 62 

News Items 106-145-181-228-2H0-329-273-301 

Note on the Crainal Nerves, L. Harrison Mettler M. D 284 

Nu Sigma Phi 432 

Obstetric Errors, A. McDiarmid, M. D 1 

Opening Exercises 168 

Our Annual Concert 209 

Our Annual Social Affair 268 

Peritoneal Adhesions, T. A. Davis, M. D 183 

Phi Rho Sigma Fraternity , 433 

Photographs of Drs. A. McDiarmid, W. L. Ballenger, Weller 

A^an Hook, J. B. Murphy, J. B. Murphy's Clinic, W. E. 

Gamble, Albert Schneider, D. A. K. Steele, D. A. K. Steele's 

Clinic, Jas. B. Eagleson, Frank B. Earle, S. H. Champlin, 

T. A. Davis, E. A. Fischkin, Jno. Lincoln Porter, A. F. 

Lempke, Geo. F. Butler, A. C. Crofton. 
Recent Progress in Bacteriology, Adolph Gehrman M. D. . . 289 

Response to the Toast "Our Wives'', Geo. Butler M. D 300 

Report of two Cases of Spina Bifida, one Operated Upon, 

the other Aspirated, Svenning Dahl, M. D 334 

Results of Widal's Tests, Adolph Gehrman M. D 41 



Index. 

Schoenborn — Beele Splints. Edward H. Lee M. D 315 

Scholarships 16 

Scholostic Paudemoiiium, W. T. Eckley, M. D 139 

Senior Notes 221-276-322-269-303 355 

Senior Social 419 

Several kinds of Doctors, G. Frank Lydston M. D 133 

Some Anatomy for Senior Students to Remember, W. T. 

Eckley M. D 275 

Some of the Class of '99 Who Have Secured Internships and 

Where 16 

Some Features in Surgical Progress, Wm. M. HarshaM. D. 156 

Sophomore Notes 223-279-324-271-304-358 

State University Bulletin 233 

The Doctor's Wooing 308 

The Early Diagnosis of Chronic Bone and Joint Diseases in 

Children, John Lincoln Porter, M. D 231 

The Illinois Society for the Prevention of Consumption, W. 

A. Evans, M. D 

The Moral and Legal Restrictions of Marriage, A. H. Burr 

M. D 22 

The Mouth and Chin of Woman as an Index of Character. . . 360 

' The Passing of Dr. Sparrow, G. Frank Lydston, M. D 169 

The Quine Library. 302 

The Purpose of Marriage, L. Harrison Mettler, M. D 25 

' The Rationale of Compression of the Lung for Tuberculosis 

A. F. Lemke M. D 249 

The Rest Cure Without Rest, Henry T. Byford M. D ...... . 229 

The Value of Clinical Observation of Skin Diseases for the 

Medical Student, Edward A. Fischkin, M. D 207 

Toast — The College of Physicians and Surgeons — By Wm. 
Twenty-Five Indications for Incision of the Membrana — 

Tympamun, William Lincoln Ballenger M. D 7 

What are We Here For? George F. Butler, M. D 281 

Allen Pusey, M. D 407 

Valedictory — By Henry E. Towhig 412 

Ventral Hernia, Following Drainage of Abscesses in the 

Region of the Appendix, Henry J. Brugge M. D 303 



ATTENTION READERS 

When ordering supplies of any kind 
order of our advertisers and mention the 

Plexus. 




A. McDIARMlD. M. D., 
Lecturer on Obstetrics, College of Physic- 
ians and Surgeons. 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDK 'AL DEPARTMENT 

UNIVERSITY OF ILLINOIS. 



VOL. V. MAY 20th, 1899. NO. 1., 



OBSTETRIC ERRORS. 
By A. McDiARMiD, M. D. 

Under this caption I desire to present certain defective and 
inefficient procedures and methods as applied during pregnancy, 
labor and the puerperal state. These features of error are com- 
monly the result of lack of thorough preliminary teaching and 
training and especially the neglect of the practitioner to read the 
current literature of the subject, and correctly interpret the 
teachings of the book of nature. Possibly also they arise from 
a want of natural adaptability for, or interest in the practice of 
obstetrics. 

The diagnosis of the pregnant state frequently offers consid- 
erable difficulty, and errors may occur even in the hands of ex- 
perienced obstetricians but are generally the result of want of 
care in applying all the known methods of investigation. I would 
emphasize the importance of thorough and patient bimanual ex- 
amination and the value of Hegar's sign in the early months of 
pregnancy. This consists in softening and compressibility of the 
lower uterine segment, which may be elicited by the use of one 
or two lingers in the vagina and the fingers of the other hand on 
the abdomen, when the portion intermediate between the more 
massive fundus and cervix is found remarkably thin and soft, giv- 
ing an impression to the examining fingers much like that of the 
empty urinary bladder. I would specially cautien against the 
use of the uterine sound for purposes of investigation after one 
or ore menstrual periods have been missed. 



2 THE PLEXUS, 

Uncontrollable vomiting of pregnane}^ may well involve error 
of judgment in regard to the necesssity for evacuation of the 
uterine contents, on the one hand leading to needless sacritice of 
fetal life and on the other to death of the mother from too long 
delay. As guides to a correct conclusion elevation of tempera- 
ture and dry skin are the most important, and should admonish 
us to empty the uterus without delay, preferably under chloro- 
form, with rapid dilatation and evacuation by means of the blunt 
curette or a bullet forceps under rigid antisepsis. Rectal ali- 
mentation must never be neglected in these cases of pernicious 
vomiting. 

The albuminuria of pregnancy involves similar considerations 
with reference to the induction of premature labor, and these en- 
force the necessity for frequent and careful examination of the 
urine and close observation of the progress of symptoms. In 
case these do not improve under appropriate treatment it is mani- 
fe.^tly wrong to allow joregnancy to proceed to the jeopardy of 
the patient's life. 

Backward displacements of the gravid uterus demand care in 
diagnosis, otherwise the disjolaced fundus may be mistaken for a 
pelvic exudate or tumor, while the distended bladder, the result 
of pressure of the displaced organ upon the urethra, as also of 
traction on the tube in the direction of its length, may be mis- 
taken for an ovarian tumor. The bladder should be carefully 
emptied by the catheter and the uterus replaced by gentle taxis, 
under anesthesia if necessary. Rest in bed, thorough tamijonade 
of the vagina, and later the employment of a suitable pessary, are 
appropriate methods until the uterus attains sufficient size to 
maintain its position above the pelvic brim. 

Extra-uterine pregnancy is exceedingly apt to escape detec- 
tion until after rupture, and even then the physician may fail to 
comprehend the true condition. In case of its diagnosis before 
rupture no more fatal error can be made than to postpone opera- 
tion. In case rupture has occurred, immediate operation should 
be the rule although undoubtedly certain cases recover by conr 
servative care without oi)eration, chiefly those of rujDture into 
the broad ligament. To wait for recovery from shock before un- 
dertaking operation is likely to prove a fatal error. 

During labor })erhaps the gravest error and greatest obste- 
trical sin is to examine the patient, or to assist her, with unclean 
hands or instruments. The graduates of recent years are not so 



THK PLEXUS. 3 

likely ta err in this respect, but I fear some of the old practition- 
ers are the worst sinners, men who affect to disbelieve in the 
germ theory of diseasa or who — g-iving: a quasi-consent — are too 
blind or too slothful to acquaint themselves with modern anti- 
septic methods. Foremost then of the factors in the success of 
all obstetrical work I would place thorough unrelenting surgical 
cleanliness. This must not be confined to the person of the ob- 
stetrician and his instiuments alone but must extend to the pa- 
tient, her surroundings and attendants. Even wiiere life is not 
directly sacrificed a violation of this law may entail chronic in- 
validism and early death. As an illustration of this may be 
mentioned chronic cystitis the result of uncleanly catheterism 
during and after labor, leading ultimately to pyonephrosis and 
death. 

Too early, or on the other hand too long delayed rupture of 
the membranes may greatly retard the progress of labor. Diffi- 
culties in delivery I am persuaded are in a large number of cases 
attributable to want of accurate knowledge of the correct mech- 
anism of labor and a lack of study of the science of pelvimetry. 
Thus it occurs that, owing to an imperfect appreciation of the 
pelvic diameters, attempts are made to employ forceps or version 
in cases only properly amenable to symphysiotomy or cesarean 
section. So too in ^he use of forceps the normal mechanism may 
be overlooked and a method of rotation adopted directly at vari- 
ance with the process of nature. Certain position are especially 
liable to be thus improperly treated, for example occipito-poster- 
ior positions. In mento-posterior positions a common and 
egregious error is to apj^ly forceps in the hope of delivering the 
head with the chin posterior. Such a procedure is certain to re- 
sult in death of the fetus and probably in injury of the mother. 
If anterior rotation of the chin cannot be accomplished podalic 
version may be instituted, or if this prove imjDracticable cesarean 
section may be employed. To rotate the head on its transverse 
axis and produce a vertex presentation, would be an ideal proce- 
dure but is rarely feasible after labor has been fairly instituted. 

In cases of poialic version, or primary breech presentation, an 
error lies in making traction on the foot or breech and so unduly 
hastening the early stage of delivery, instead of allowing ample 
time for complete dilatation of the birth canal, thus preparing 
the parts for the speedy delivery of the after coming head. By 
this traction too w^ may produce extension of the head and pos- 



4 THE PLEXUS. 

sibly of the arms, and, by failure to rotate the shoulders into the 
antero-posterior diameter of the outlet, the chin may become 
locked over the symphysis. It must be remembered that no dan- 
ger accrues to the child until the umbilicus appears at the vulva, 
after which compression of the cord, diminution of the area of 
the placental site, and compression of the placenta combine to 
•jeopardize its life. Delay beyond a period of from four to eight 
minutes is likely to prove fatal. A trust to nature plan is in- 
excusable. 

In the third stage of labor neglect of manual control of uter- 
ine contractions, and undue traction on the umbilical cord, as well 
as unnecessary introduction of the hand into the vagina or uterus 
are to be avoided. On the other hand such vigorous knead- 
ing and compression as to cause serious discomfort is unneces- 
sary and improper 

Of all the modern aids in childbirth none is more beneficial 
and merciful than anesthesia, and for this purpose chloroform is 
undoubtedly the best agent. Its less bulk and convenience of 
administraticjn without the aid of an assistant recommend it in 
preference to ether, and its use is practically unattended with. 
danger. It is eminently improper to deny to the suifering par- 
urient this beneficent boon. Even in case of cardiac disease it 
need not be withheld. 

Ergot is often needlessly and improperly used and is seldom 
necessar}'. The majority of cases proceed without tendency to 
hemorrhage or subinvolution without its use, while its adminis- 
tration before the birth of the head may be attended by the 
gravest consequence. It ought never to be given to overcome 
inertia during the first or second stages of labor, as it is liable tO' 
cajse asphyxia\)f the child or rupture of the uterus. 

Lacerations of the genital tract demand immediate suture. 
That it becomes a matter of doubt whether the lesion is of suffic- 
ient degree to demand suture may usually be taken as evidence 
of its necessity. To neglect it is to fail in the discharge of one's- 
whole duty. 

Post-i)artum hemorrhage is undoubtedly often due to error 
of management, such as undue haste in delivery and lack of early 
precautionary manipulation and comx)ression of the uterus, or to- 
undue traction on the cord or ^placenta. Nor is it sufficient 
mf r. ly to have arrested the hemorrhage, for the patient unaided, 
may still parish a few hours later without further loss of blood 



rilE FLKA'i'S. 5 

We must not neglect to restoi-e to the bloodvessels, as rapidly as 
possible, the necessary amount of circulatory fluid. This may be 
accomplished in moderate cases by exhibiting milk and other 
fluids by the mouth, or milk, or normal salt solution per rectum, 
and in severe cases by subcutaneous (sub-mammary) or intra- 
venous injections of normal salt solution. 

In cases of eclampsia a fatal issue may attend the error of 
delay. I immeiiately place the pitiant, if in labor, under chloro- 
form, and make every other remedy secondary to this, and have 
never seen a convulsion occur during its thorough adminis- 
tration. Failure comes from timidity in its use and allowing the 
patient to recover from its influence before delivery is completed. 
All reasonable haste in delivery should of course accomjianyitsuse. 

Intrauterine injections ought not to be employed unless the 
indications are unequivocal, and then by means of the irrigator 
rather than the syringe. Too great force should not be used, 
hence the reservoir should not be more than twelve or eighteen 
inches higher than the uterus, and the stream should flow 
through the tube to expel all air before its introduction. 
Sudden death has attended the incautious use of the intrauterine 
douche. 

In the use of forcejis error may consist in their too early 
application, or j^erhaps more commonly in too long delay, but too 
rapid extraction is probably the most common of all errors. 
Other improiDrieties consists in their attempted use in impossible 
positions, or in order to force rotation, and also in improper 
direction cf the traction. One should avoid too forcible or pro- 
tracted compression of the handles and these ought never to be 
fastened together. It has been taught that artificial rotation of 
the child's head beyond a quarter of a circle is attended with 
fatal results, but this has been disj^roven by Farmer 

In a face presentation we must not fail to maintain extension 
of the head by pressure upon the forehead if necessary. If 
rotation does not occur we may try by the aid of anesthesia to 
rotate with the hand, or occasionally we may succeed in convert- 
ing it into a vertex presentation. Finally the forceps may be 
cautiously tried to promote rotation, but we must again distinctly 
inveigh against the serious error of endeavoring to forcibly drag" 
the head through the pelvis with the chin directed posteriorly. 
Such an attempt can only end in disaster to the child and prob- 
ably in injury to the mother. 



C THE PLEXUS. 

In transverse positions of the vertex or of the face, it is neces- 
sary, to avoid error, to observe carefully the mode of applying 
the forceps For example, if the occiput, or in face case the 
chin, be directed toward the rigiit side, of the pelvis, the con- 
cavity of the pelvic curve of the blades must also be directed 
toward that side, so that after rotation the curve of the forceps 
may correspond to the curve of the parturient canal. The same 
Xn-inciple is true of course of posterior positions, and where 
the blades are ai)plied, reversed i. e., with their tips directed 
backwards, that blade must be first applied which is nearest 
the perineum at the lock. It is not surprising- if the general 
jtractitioner should fall into error in this latter regard inasmuch 
as the American Text-Book of Obstetrics gives precisely contrary 
directions. 

Failure to make traction in the direction of the axis of that 
portion of the canal in which the head is located is a frequent 
error, but probably the most common mistake is that of undue 
haste in delivery. A case that would require several hours if 
left to the natural forces, certainly ought not to be delivered in a 
few minutes by the almost continuous and vigorous use of the 
forcej)s; yet such I am j^ersuaded is a too common practice. 
The combined strength of two or more persons applied to the 
forceps, or a sudden slipping of the instruments, are certainly 
not striking illustrations of their skilful use. 

Another error in judgment consists in endeavoring to 
deliver a difficult case, in which the child is already dead, by 
means of foi'ceps, instead of performing craniotomy. The same 
principle holds true in regard to the performance of embryo- 
tomy upon fetal monstrosities. Embryotomy however ujDon the 
living child is rarely if ever a justifiable operation. . 

In cases of puerperal septicemia a most seductive error is 
that of endeavoring to convince one's self that the rise of tem- 
perature is due to other than septic influences. It is better to 
suspect all such conditions and treat them accordingly. 

10.3 State street. 




\V. L. HALLENGER. M. D , 

Lectiirci- on Kliiiiolojry mid Laryiiirolony. Colleifi-of I'liysiciiiiis aud 
Surgeons. 



TWENTY-FIVE INDICATIONS FOR INCISION OF THE 
MEMBRANA TYMPANUM. (MYRINGOTOMY.) 

A COMPILATION OF WELL RECOCJNIZED FACTS. 

By William Lincoln Ballenger, M. D. 

Xiecturer on llhiuolugy and Laryngology, Medical Department of the Univer- 
sity of Illinois. 

PCRPOSES. 

1. To afford an exit for serous, catarrhal, purulent, and 
other fluids from the middle ear cavity. 

2. To relieve the pain due to tension. 

3. To relieve tension of the labyrinth. 

4. To open middle ear cavity for certain oi^erations. 

5. To allow sound waves to reach the oval and round 
windows. 

THE INDICATIONS. 

A. In the Secretive Form of Catarrh paracentesis maj- be 
indicated as follows: 

• 1. If after several days treatment the exudate does not 
decrease. 

2.* When no exudate is seen and Politzerization is followed 
by relief for only one or two days. 

3. Where the exudate is copious, paracentesis may be done 
without preliminary treatment thereby hastening- the cure.- 

B. In Acute Myringitis the lance may need to be used when 
the following indications are present. 

1. In abscess formation between the layers of the tympanum 
to prevent the pus entering the middle ear cavity. Care should 
be exercised to avoid incising the entire thickness of the drum- 
head. 

2. When pearly gray blisters appear on the drumhead they 
should be pricked if they have not already sj^ontaneously dis- 
charg:ed their contents, 

3. Inflammation of the deeper layers with bulging reddish, 
bluish swellings should be lanced to relieve the pain and tension. 
Care should again be exercised to not penetrate the entire thick- 
ness of the drumhead and thereby allow the pus and germs to 
^nter the middle ear cavity. 



01 Tin: FLEX IS. 

C. Tenotomy of the Tendon of the Tensor Tympani Muscle.. 
1. The incision is made as a preliminary step in the teno- 
tomy of this muscle. 

D. Thickened Di-umhead. 

1. The incision is indicated in this condition when it is- 
desirable to relieve the tension upon the labryinth and to allow 
sound waves to reach the oval and round windows. Effort 
should be made to establish a permanent opening in the Mem- 
brana Tympanum. 

E. Acute Inflammation of the Middle Ear. 

1. To relieve severe pain (attended with or Mdthout fever) 
which resists other treatment. 

2. Where circumscribed red spots or protuberances are on 
the drumhead. 

3. Where the most bulging portion of the drumhead is of a 
yellow greenish color. 

4. In excessive livid swelling of the cutis (outer layer) 
suj^erticial scarification often relieves pain. 

F. Acute Suppurative Inflammation of the Middle Ear. 

1. Bulging drumheads with greenish color, severe jiain,. 
fever and brain symptoms call for immediate incision. 

il. Where there are symptoms of mastoid involvement. 

y. Severe pain unaccompanied by bulging. 

4. Symptoms of pus retention after closure of the primary 
opening, either natural or artificial. 

G. Adhesive Processes in the Middle Ear. 

1. To permit waves of sound to reach the labyrinth in cases 
where there is anchylosis, adhesions, etc., impeding waves from 
the membrana tympani reaching the foot plate of the stapes. 

-. To restore equilibi'ium of air pressure, in the middle ear. 

3. Extensive calcarious deposits in the drumhead and 
where there is abnormal thickening of the drumhead are indica- 
tions for paracentesis. 

4. Fixture of malleus and incus by immediate ligamentous 
union with the walls of the t^ympanic cavity. 

5. Stricture of the Eustachian tube which cannot be relieved 
by electrolysis or dilitations by means of Eustachian bougies. 

6. In excessively loud .subjective noises if they cannot be 
relieved by other methods. 

7. To carry out intra-tympanic operations ux)on adhesive 
bands and ankylo.sed ossicles. 



THE PLEXUS. 11 

H. Atrophy and relaxation of membrane. 

I. Diagnostic purpose. 

1. Superficial scarification may aid in restoring the drum- 
head to its normal tension. 

2 In Ch. Sup. when the perforation is small and high. 
methods of operating. 

Preliminary examination of function of hearing 
should be made before performing paracentesis for adhesive 
processes and dry catarrh. Bone conduction for watch and 
tuning fork C2 should be good, otherwise but slight improve- 
ment should be expected to follow the operation. 

A. Discarded methods. 

1. Excision of portion of membrane (Myringectomy). 

2. Excision of the handle of the malleus (Wreden's sphoi'ot- 
omy). 

3. Crucial incision and cauterizing with nitrate of silver 
and sulphuric acid. 

B. Electro-cautery paracentesis in adhesive non in- 
flammatory cases. 

1. The electrode should be a simple straight pointed one 
with the shank bent at such an angle as to offer no obstruc- 
tion to the view of the operator. 

2. Instantaneous red-heat should be obtained in order to pre- 
vent the operation being joainful. 

* 3. Contact with the drum-head should be made before 
closing the circuit. 

4. Time of heat contact; from one-half to one second. 

5. The pressure should be very slight, otherwise the inner 
wall of the tympanum may be injured. 

C. Incision with lancet. 

1. Instruments. A double edged or spear shaped lancet 
was formerly used as only simple paracentesis was desired. 
Preference should be given however, to Hartman's curved lancet 
as a free incision affords greater relief. 

2. Anaesthesia. When the drum- head is bulging from 
fluids in the tympanum the incision may be made without pain. 
In other conditions an instillation of a twenty per cent. sol. of 
cocaine should be used for some minutes prior to the operation. 

3. The most suitable location for the incision is usually in 
the post- inferior quadrant, as it is more accessable, and farther 
removed from the inner tympanic w^all. 



12 THE PLEXUS. 

4. If fluids are present the bulging- portion of the mem- 
brane should be incised. 

0. The lenofth of the incision should be two to four mm. 

POST OPERATIVE CONSIDERATIONS. 

1. Immediately after the operation a pulsation, or move- 
ment synchronous with the act of swallowinor, and articulation 
will occur at the i:)oint of incision. Rarely will pus or mucus 
appear at once. 

il. Polizerization will force the secretion into the external 
meatus. In some cases the mucus is so tenacious that it cannot 
be removed by this method. Suction by means of the Delstanche 
masseure will usually succeed. Air may be compressed in the 
external meatus thereby forcing the mucus out through the 
Eustachian tube. Strings of heavy mucus may be removed 
with forceps. Instillations of warm soda solution or hydrozone 
will facilitate the removal of heavy mucus or pus. 

3. Closure of the wound usually occurs within one or two 
days in nonsujipurative cases. 

4. Dressing. The external meatus should be packed with 
sterile gauze or cotton after thoroughly asej)tasizing the auricle 
and external meatus. 

100 State St. 



Announcement has been made of the engagement of Dr. 
W. H. G. Logan, D. D. S. , Professor of Dental Surgery. College 
of Physicians and Surgeons and Miss Brophy daughter of Truman 
W. Brophy, Dean, Chicago College of Dental Surgery. 

Dr J. M. G. Carter of Waukegan writes. "I lepve to-day for 
a trip to Europe. Will visit hosj^tals in Paris, and take a sniff 
of Switzerland air. 



A (iUARANTEED CUl^E Ft R SI R]N(; FLVl K. 

Sx^ring Fever, which is rcw the pn "\ ailirg ccnilaint will very 
quickly be cured by taking thefolk.ving i rescii})tion. 

Hard work, l)arts X 

I Food and drink, well chosen •' II 

^ Recreation, profitable " IV 

i! Sleej), good, sound, at pn^per hours. '• Vill 

Met Sig. 
W Twenty-foui- ])arts. to be taken each d; y until cuied, and 
afterward in moderation to prevent a spi bad-.. 

HuEi. Breeze, M. D. 



THE PLEXUS 

THE OFFICIAL UlUiAN UF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MKDIC'AI. DEPARTMENT 
UNIVERSITY OF ILLINOIS. 



Editor, H. J STEGEMANN, '02. Business Mgr. G. G. DOWDALL, '00. 



Class Editors: 
F.C. BLACK WELDiER. 00. W. O. McDDWELL, '01. J. M. MEYERS, "02 



Faculty Department, Dr. W. A. Piisey. Athletics, 

Alumni, Da. Louis J. Mitchkll, 71 L:iiliii Street. Clinical Dspartmeut. E. A. Gansel 



Publishers. DOWDALL & STEOEMANN. 

Subscription 51.00 per Annum in advance. Single copies. 15 rents. Issued Montlily 
duiih}; ilie \\ inier.uid Spriii'z Sfssiotis. Send :i,ll I'l'm itta rices and com municiitiijns a.s to 
subsci'iinions and advertisinji to G. O. DOWDALL. Business Manager, 8i;j W. Harrison St. 
Entered at (Jliicago i'ost Office as Secoiid-C'lass Matter. 



A Tiv subscriber' desirinir tlie . Journal discontinued at tlie expiration of his subscription 
slioutd so notify tlie Publisliers: otiierwise it will be assumed 'Jiai tlie subscription is tol)e 
continued aiidtiie .Journal >erit accordingly. 

t'ontributions of matter suitable for pul)licai ion are invited, and should be sent in not 
later than the 25tli of ilie motitli previous to that of publication. Tlie publisliers willuot hold 
tliemselves responsible for the safe return of MSS unless sufficient stamps are forwarded. 

EDITORIAL. 

P. & S. agaiu wins first honors at the Cook County examina- 
tions for internes against Rush and Northwestern. Let the good 
work g'o on. 

Have you seen it? Tlie new Murphy button which made its 
appearance last month. While totally unlike its predecessor, it 
gives a very clear conception of the wonderful scope of useful- 
ness the Doctor fills in this scientific age. 

* * 

Dr. Quine, wiio delivered the charge to the class at the grad- 
uating exercises, stated that the reason that Dr. Murphy, who 
was to have delivered the charge, did not do so, was, Dr, Murj^hy 
charged too much. Are we to understand from that that Dr. 

Quine is a cheap many 

* * 

•K- 

Dr. Nicholas Senn, it has been reported, is to be our next 



14 THE FLEXLTS. 

Governor. "We hope that when he is elected he will do away 
witti the old established and barbarous custom of using an axe to 
cut off the heads of all obnoxious office holders and use the more 

humane and scientific method, the surgeon's knife. 

* * 

When we thanked those who so promptly responded to our 
call for the wherewith to conduct a journal we did not wish to 
infer that we had all we could use. We still appreciate all that 
comes to us. When remitting, if you are an alumnus, add twen- 
ty-five cents to our bill to pay the Alumni Association dues and 
keep in touch thereby with your classmates with whom you grad- 
uated. 

* * 
* 

The question as to whether the requirements for admission 
to the study of medicine should be increased is given an affirma- 
tive vote in the following, which are orders sent to the curator 
during the past year. 

These are but a few of the "cui^ios'" received during the year 
but they will suffice to show that the standard of the Medical 
Profession can not be raised by admitting to the ranks students 
who are so deficient in the ordinary educational accomplishment,, 
as that of spelling. 

1 Piest cheesse clothes 

won bunsten's burner and host 

one ounst Coronoid's solution 

one motar and pistle for Mr. Fanatuses Class. 

1 bot-Excylol. and Sideral 

2 beechers and a speciment-box. 

1 hotels eather and chloriform, each. 
One slite bocks and porzelan dishes 
Lattimus papers blew — for asids 
Zedyr oil for mounding specimen ts. 

* 

It is with deep regret that we learn of the resignation of Dr. 
Wm. E. Quine as Dean of the College of Physicians and Surgeons. 

Dr Quine was the first Dean of the College and has occupied 
t'lat resi:)onsible position ever since the affiliation of the College 
o! Physicians and Surgeons with the University 'of Illinois, in 
1897, and a better man for this important position could not have 
been .selected. 

The present high standing of the College of Physicians and 



THE PLEWU.S. 15 

Surgeons in the medical educational world is due, no little, to 
his efforts and able management. 

Being a man of fairness in all things, broadminded, and hav- 
ing always before him the paramount interest of the school, has 
won him the respect and esteem of the great student body. 

Dr. Quine stands at the pinnacle of medical science and no 
more efficient person can be found to deliver the scientific and 
instructive didactic lectures that it has been his duty to present 
to the senior class each year, and should he decline to reconsider, 
the school, as well as the student body, will have lost one of its 
most earnest and conscientious workers. 'Tis said the reason for 
his resignation is his inability to devote the time necessary to 
fulfil the duties of the office. 

We sincerely hope that the Doctor will see his way clear to 
reconsider his determination to resign and that he will continue 
to be, as heretofore, one of the most earnest supporters of the 

College of Physicians and Surgeons. 

* * 

• 

We are exceedingly interested in creating a more friendly 
and fraternal feeling among the Alumni of the P. & S. and as a 
means of fostering and bringing about such a pleasant state of 
ajffairs we will (beginning with the June issue) publish original 
articles, of interest to the Medical Profession, written for the 
Plexus by graduates of the P. & S. school. We do not mean to 
discontinue jjublishing the very worthy articles contributed by 
the Faculty, these will continue as heretofore, but we will devote 
a certain space for the contributions of the Alumni. 

Quite a goodly number of years have gone by since the first 
graduating classes of this school received their diplomas and each 
succeeding year has shown an increase in numbers and a corres- 
ponding increase in importance in the medical world of the school 
itself, until now, the limit to the number of students that can be 
accommodated is almost at its greatest, necessitating an increase 
in room and facilities, which, we are pleased to state, will soon 
be a reality, and the school has become a recognized leader 
among medical institutions. 

Out of the great body of students that have graduated from 
this school, many have attained great prominence in the medical 
fraternity and we are proud of them and we are sure, too, that 
the contributions we hope to receive from them from time to time 
will be interesting reading. Many others, who from lack of op- 



16 TEE PLEXUS. 

portuuity to distinguish themselves and not so well known per- 
haps, are equally capable and can contribute articles that will be 
just as interesting-. 

In connection with the articles we hope to have the pleasure 
•of printing a likeness of the contributors; thus, perhaps, gradu- 
ates of years gone bye may again see what one of their classmates 
looks like today. 

We extend to you a cordial invitation to contribute any arti- 
cle, interesting case or other matter that will be of interest to 
the Profession or the Alumni. Will you accept the invitation 
and help us t o ccomplish our object":' 



SCHOLARSHIPS. 

The scholarship students for the year 1H98-99 are: 
Freshman Year — H. J. Stegemann (Gold medal). 

H. C. Caldwell. 
Sophmore Year — M. S. Jordan (Gold medal). 

J. W. Birk. 
Junior Year — Margaret J. Babcock (Gold medal). 
S. Jakubowski. 

SOME OF THE CLASS OF '99 WHO HAVE SECURED 
INTERNESHIPS, AND WHERE. 

COOK COUNTY HOSPITAL. 

Theodore Tieken. 
Bernard Fantus. 
A. W. Stillians. 

E. R. Whitmore. 

F. G. Harris. 

G. S. Browning. 

ALEXIAN BROTHERS HOSPITAL. 

F. G. Harris. 
.T. P. Grimes. 
A. F. Lempke. 

G. S. Browning. 

WEST SIDE HOSPITAL. 

J. C. Betz. 
(t. 8. Browning. 
J. E. Metcalf, 
1st alternate. J. H. Turner. 



1st 


place. 


5th 


•' 


10th 


( i 


12th 


( ( 


1st alternate. 


4th 


i i 


1st 


place, 


3rd 


'- 


5th 




1st alternate 


1st 


place, 


2nd 


( i 


3rd 


I ( 



THE r LEXUS. ir 

CHICAGO HOSPITAL. 

J. R. Taylor. 
J. M. Edwards. 
J. H. Dugan. 

LAKESIDE HOSPITAL 

H. H. Bay. 
J. V. Wenzel. 

ST. ELIZABETH HOSPITAL. 

L. Feingold. 

MICHAEL REESE HOSPITAL. 

Ira Frank. 

MARY THOMPSON HOSPI LWL. 

Miss H. L. Hukill. 

NORWEGIAN HOSPITAL. 

J. W. Backus. 

MEiiCY HOSPITAL, Diibuque, la. 

Frank W. Meyers. 

HOSPITAL FOR INJANE, Clarinda, la. 

J. H. Wherry 



A GOOD LOCATION. 

•Oa Crooked Creek, eleven miles frjin nearest R. R. Station, in a nice 
quiet place. 

A letter addressed to Physicians and Surgeons of Rush Med- 
ical College, Chicago, 111., which reached the P. & S. College by 
mistake last week, reads as follows: 
Physicians and Surgeons of Brooklyn, Ills., May 16, 1899. 

Rush Medical College, 

Chicago, Ills. 

Gentlemen, 

Have you Physicians Wanting a Location. If so 
and he is the Right kind of a man i think there is a good chance 
here. We have one M. D. but he Does Not give Satisfaction i 
will give a few References who he can correspond with. (Here 
follows a list of one merchant, four farmers and one farmer 
teacher) all of Brooklyn i Can give More if Necessary. Brooklyn 
is a Village of 300 inhabitants Situated on Crooked Creek (on 
Some MajDS as Lamain River) Eleven miles from Nearest R. R. 
Station with a fairly good Surrounding Country a Nice Quiet 
Place to Live i am Satisfied the Right kind of a Man one who 
will attend to his business Can Do well here. 



18 



THE PLEXUS. 



hoping you have a man and he will correspond with Refer- 
ences sent and it May Prove a banafit to him as well as the Com. 
munity. I Remain 

Yours Respt. 
address Mvself as above Jos. E. Burton. 

Brooklyn/lll., Schuyler Co. 

Mr. Burton certainly knows where to inquire for Dead ones, 
had he wanted a live one he would have called on us. (No hard 
feeling, Friend Rush.) — Ed. 

HURRAH FOR US! 

At the Cook County examination for internship held April 
17, 18, 19, P. & S. again carried away first honors. 

Dr. Theodore Tieken, in competition with fifty-one others 
made the best record, thereby securing first place. 

For the j^ast three years, a graduate from this school has 
headed the list, and it is gratifying to know too that in pro- 
portion to the number of candidates presenting themselves for 
examination those from the P. & S. show the best averages. 

The following table gives a comparison for the past two 
years, the record for 1897 not being obtainable: 

WINNERS OF FIRST PLACE. 

1897 Peter Bassoe P. & S. 

1898 John N. Neff P. & S. 

1899 Theodore Tieken P. & S. 

1898 RECORD. 



P. AS 

Rush 

Chicago Med. 
Woman's " 
Harvey ' ' 



Numl)fr 

WllO t(JOlv 

the exam- 
ination. 



11 

14 

13 

5 

1 



> luiiber 

who 

secuivd 

inter n e- 

shi))-s. 



Pe re e n t- Averag 
age. J'lace. 



Avei'age 



e.vanii na- 
tion 



36r\ 

4:2f 

20 




14tV 


500.7 


19jf 


499.11 


- ' T 3 


456. 


27 


455.9 


19 


475.5 



out of a pos- 
sible 75ti. 



-1899 RECORD. 



P. & S 

Rush 

Chicago Med 
Woman's " 



11 


5 


45,\ 


i«A 


342.3 


19 
13 

H 








'>0 1 3 

30|f 
3(H 


337.1 
286.2 
285.6 



out of a pos- 
sible 500. 



The winners in this last examination are given here in the 
order in which they stand according to the grades made in 
■answers to the questions appearing below. 



1st place 


2ud 


' 


3rd 


' 


4th 


i 


5th 


i 


6th 




7th 


' 


Hth 




9th 


( 


10th 




11th 




12th 


' 



77/71 I'LILM S. lU 

Tieken P. & S. 411.0 

" Roe Rush 406.9 

" Keller Rush. 395.8 

" Thompson Rush. 392.7 

" Fantus P. & S. 390.6 

" Lewis Rush. 389.8 

" Sheldon Rush. 376.6 

'• Miller CM. 383.6 

" Ochsner ^....Rush. 371.9 

'^ Stillians P. & S. 370.7 

" Kanavel CM. 36^^.4 

" Whitmore P. & S. 367.5 

1st alternate Harris P. & S. 360.7 

The following questions were propounded and constituted 
"the examination for "99. How many can you answer correctly? 

PATHOLOGY. 

1. Results of Pulmonary Embolism. 

2. Describe Diphtheria Bacillus. 

3. Pathology of Locomotor Ataxia. 

4. Mention various structures in which x>i'iniary carcinoma 
may develop. 

5. Principal anatomical lesions of congenital syphilis. 

MEDICINE. 

1. Give cardinal symptoms which speak first, for, second, 
against typhoid. 

. 2. Describe degenerative processes following haemorrhage 
of the brain in internal capsule. 

3. Diagnosis of Liver Abscess. 

4. The Urine in Typhoid. 

5. Differential diagnosis, round ulcer and carcinoma. 

GYNECOLOGY. 

1. Describe the operation of Vaginal Hysterectomy and 
state how you would avoid accidents in performing same. 

2. Briefly describe the morbid anatomy of Gonorrhea in the 
female. 

3. What are the essential elements in the production of os 
uterine prolapse. Give treatment of each causitive element. 

SURGERY. 

1. Give differential diagnosis and treatment of urinary 
calculus. 

2. Give differential diagnosis and treatment of the fifth 
cervical vertebrsB. 



20 THE PLEXUS. 

3. Symptoms of gall stones located in gall bladder, in- 
cystic dnct and in common duct. 

4. Give the pathogenesis of acute osteomyelitis in long- 
hones. 

5. Diagnosis and te^-hnique of oj^erations for thrombosis of 
the sigmoid sinus. 

6. Give causes and treatment of delayed union of fracture 
and pseudoarthrosis. 

7. Give differential diagnosis of dilferent kinds of goitre 
and treatment of each. 

1. Therapeutics of opium. 

2. ' Dose of atropine sulphate, zinc sulphate, dilute sulphuric 
acid, sodium sulphate and calcium sulphide. 

8. Therapeutic use of water. 

4. Action of thyroid-extract. 

5. Diagnosis and treatment of arsenical poisoning. 

OBSTETRICS. 

1. Diameters of foetal head at term, and of female pelvis. 

2. Diagnosis and management of placenta previa. 
8. Care of mother's breast during puerperum. 

4. Usual sources of infection of puerperal women and how 
avoided. 

5. Puerperal Eclampsia post partum and how treated. 

ANATOMY. 

1. Brietiy describe knee-joint. 

2. Give branches of internal maxillary artery. 

8. The sphenoidal fissure where: and what structures pass 
through it. 

4. Surgical Anatomy of Inguinal Hernia. 

.". The circumflex nerve, its origin, function and dis- 
tribution. 

B. What is Stenson's duct, Wharton's duct, ductus Riven- 
son? Canal of Nuck, gubernaculum testes, membrane Eborsis. 

EYE. 

1. Differential diagnosis between iritis and acute inflam- 
matory Glaucoma. 

2. What is opthalmia, meonatorum symptoms and treat- 
ment. 

;'. Give sym])toms of acute mastoiditis, what are indications 
for operation' 



PHYSIOLOGY. 

1. Describe the various forms of white blood corpuscles; 
what percentage of each makes the whole; what are their 
functions y 

2. Composition and uses of bile. Location of Brunner's 
glands, Lieberkuhn's glands, Pacinian corpuscles. To what salts 
is the acid of urine due'^ 

3. What elfect would follow the division of the sensory- 
root of the fifth nerve. How can the respiratory movements be 
modified by sensory impulses':* 

4. What is an enzyme; w^hat properties do they have in 
common; what enzymes occur in the human body, and what is 
the function of each? 

5. Name the various forms of sugar found in the human 
body and give their chemical formulae. Reaction and average 
sp. gr. of blood. Daily amount of urine and urea excreted by- 
man of average size and weight; what is the chemical compo- 
sition of perspiration. 

CHEMISTRY. 

Define polymorphous, isomorphous and amorphous. Signi- 
ficance of the sylables di, penta, tri, mono in chemical nomen- 
clature. State signification of ic, ilt, ous, ate, ide. 

2. What is meant by specific heat; compare specific heat of 
iro\i and water; what happens when benzoic and salycilic acid 
are heated with lime; what is the important substance formed? 

Give atomic weight and valence of carbon, arsenic, sulphur, 
hydrogen, zinc, oxygen, phosphorous. Give formula of ether, 
chloroform, tartar emetic. 

4. What is an aldehyde; formula and valance of hydroxy 1, 
carboxyl; formula of urea; name a monobasic and a dibasic acid; 
name a hydrocarbon and give formula. 

5. How many volumes of hydrogen and nitrogen respect- 
ively, are required to make two volumes of ammonia; what are 
the cardoveric alkaloids and to what group of substances are 
they analogous? Complete the following: 

3 CuS -I- 8 HNO3. MnOg -!- H^SO,. 



THE MORAL AND LEGAL RESTRICTIONS OF 
MARRIAGE.* 

One of the most powerful and universal laws of Animate 
creation is the sexual instinct whose fundamental object is the 
perpetuation of generic life. Normally it promotes physical 
perfection through the law^s of natural selection and survival of 
the fittest. Man, the thinking and talking animal, is the excep- 
tion. The type of physical perfection is the rule among all 
other animals. It is the rare exception among civilized mankind. 
Man is the only animal permitting the deformed, diseased and 
degenerate to perpetuate their anomalies by unrestricted breed- 
ing. He ignores all rules of stirpiculture in the choice of his mate 
and the rearing of his own kind. He puts blinders on his horse 
sense and hands the reins over to unreasoning sentiment, to 
ignorant cajjrice, mercenary considerations or selfish lust. 

The fundamental object of the mating of the sexes is the 
procreation and care of offspring, not barring other exceptional 
and legitimate incentives. Behind all is the impelling sexual 
instinct as a conscious or subconscious psychic force adapted to 
this end. The home, the state, commerce, science and the arts 
are corollaries and adjuncts of these basic principles. 

Marriage has its dangers as well as its responsibilities w^hich 
the parties to the contract and society itself ought not to ignore. 

A defective parentage is the greatest factor in the appalling 
loss of one -half the human race during the *irst five years of life. 
It is responsible for a large share of the burden of our state- 
charities and penal-institution Individuals with serious mental 
moral or physical defects have no moral right to marry and 
transmit a heritage of suffering and premature death. 

Among the ancient Greeks the fundamental idea in the 
evolution of citizenship was the develojoment of physical per- 
fection in the beauty, strength and symmetry of the human form. 
To this end the youth of both sexes were trained in the gym- 
nasia. The laws of Lycurgus cut off the defective infants. The 
dams and sires of the nation were mature and wholesome types 
of manly and wcnnanly perfection. By the vigor and endurance 

♦Abstract <if Dr. A.M. Hum's paper re i<l l)ef( re the Pliysioiuns' Club, Apr. a4. '98. 



THE PL EX LIS. 23 

and courage of her eueinies the Grecian sceptre dominated all 
the races of the known world. 

This love for and development of grace and perfection in 
the human form, had its flower and fruitage in the beauties of 
the Greek tongue, which has transmitted models of poetry, 
oratory and philosophy to all ages. It inspired the chisel of a 
Phidias and Praxiteles whose art has been the despair of sculp- 
tors in every land. It threw a charm about the temples of 
Athens, which holds the traveller spell-bound amidst the decay 
of centuries. 

We may well question the institution of marriage under 
modern civilization and compare its lack of salutary restrictions 
with the practical results of other ages. The only available 
remedy at present seems to be moral regulation through en- 
lightened public sentiment. Our youths should be trained 
morally and physically for the duties to be assumed in the 
marriage relation as a part of public education. The principle 
should be inculcated that individuals having serious trans- 
mi ssable defects of any character, have no more right to inflict 
them upon their progeny than they would have to injure their 
neighbors to the same degree. In this light many marriages 
are crimes against partners to the contract, against children of 
such a union, and against the common wealth. 

Let us consider some of the more serious dangers which can 
only be remedied by legal restrictions. The right of the indi- 
vidual to protection by the state from injuries which he is 
powerless to avert is a well recognized principle. Preventive 
medicine has made great advances in recent years through 
governmental aid. The great epidemic scourges of former 
times are now prevented or soon stamped out by wise sanitary, 
quarantine and vaccination measures, but the widespread 
endemic and dangerous every-day diseases of tuberculosis, 
gonorrhea and syphilis that terminate more lives and cause 
more distress annually than all the combined epidemics of a 
century, to these we are singularly blind. Why? Simply 
because they are every dan, chronic diseases. 

Life and health are often sacrificed on the marriage altar 
through a pre-existing infection of a partner in wedlock. When 
we add to these the effects of transmi ssable mental and neurotic 
diseases, like insanity, ejDilepsy, and alcoholism, all casting a 
blight on progeny from fatal existence to the grave; it does seem 



•24 THE PLEXl;<. 

high time to quarantine the marriage license and detain the 
candidates long enough for careful sanitary inspection and the 
exclusion of such as are a menace to life, or health of wife, hus- 
band or probable otfspring. 

The ravages of these preventable diseases, carried so often 
into the marriage state is beyond estimation. Hence it would 
seem rational to assume that all persons entering the bonds of 
wedlock have a right to know that their bodies shall not be 
contaminated in this relation by the already existing diseases of 
a proj^osed partner. They have a right to know that their 
progeny shall not be victims by heredity or infection from the 
same source. The unborn child has its recognized legal rights. 
Among these should be placed the inalienable right to be born 
free from the blight of clearly preventable diseases. We hold 
that it is plainly obligatory on the part of the state to protect 
those who from the nature of the case are powerless to protect 
themselves from the dangers to which an unsanitary marriage 
may subject them. 

An institution so essential to the highest good of society 
.should have few barriers imposed against those qualitied for its 
duties. Restrictions have been so far confined to questions of 
consanguinity, ability to make a contract, minority and mis- 
cegenation. 

The state of North Dakota just redeemed from a pernicious 
divorce law has led all other states in this needed reform by the 
Creel bill to regulate marriage, passed Feb. 25, ■!^»9. Under this 
provision no license to marry can be granted till applicants 
present a certificate from a board of examining physicians show- 
ing freedom from infectious venereal diseases, epilepsy, habitual 
drunkeness, tuberculosis and hereditary insanity. Similar bills 
are up or soon to be presented in other states. It is to be hoped 
that all the union will follow this beneficient legislation for the 
protection of wives and children from contaminations that 
endanger, not only the health and happiness of homes, but the 
very welfare of our nation. 

:i.=S04 Ellis A v.- 



THE PURPOSE OF MARRIAGE* 
By L. Harrison Mettler, A. M.. M. D. 

■•Curse on all laws but those which love has made. 
Love, free as air, at sight of human ties. 
Spreads his light wings and in a moment Hies/" 

In the words of the poet so moaned the fair Eloisa to her 
Abelard. "Unhappy pair" mused I as I stood beside their arrave 
one summer's day amid the quiet of Fere Lachaise, "after the 
jealousy, hate, bigotry and envy of mankind had forever 
destroyed your happiness, ye are at last lockei in eicdi other's 
arms and in death find the calm and peace which human inter- 
ference denied you while on earth!'' Unhappy seems to be the 
course of love if the poets sing true. Th? world applauds a 
Romeo and Juliet as an ideal idyll of love and j^et how sad is the 
tragedy of its close I We sigh while Wf condemn the loves of 
Francesca and Paolo, wondering at the decrees of Fate by which 
the noblest emotion of the human heart, should be so nearly 
akin to sorrow and death. Why is it that that upon which 
marriage, the sweetest, the most divine of human relationships, 
.is primarily founded should be the source of so much wretched- 
ness! Where lurks the poison by which the very sunlight of 
human existence is at times converted into impenetrable black- 
ness? Methinks I hear some one say, that it is unbridled passion 
and not true love that brings miser}' and despair in its wake. 
That is not always so however, for misery and despair have 
lifted up their ogre countenances when love was pure and 
chaste, when passion was unknown, when naught but ill-mating 
could be assigned as the cause. The human heart is capable of 
intense emotions. Intense love nestles in the same breast 
wherein abides the possibility of an equally intense grief. 
Marriage is founded upon love; the deeper the love the more 
profound may be the sorrow if that love is disturbed. As a 
delicate watch may be ruined by rough -handling more readily 
than a piece of coarser mechanism, so the exquisite delicacy of 
the purest love may be hurt by interference more than some of 
the grosser relationships of life. For this reason mankind in all 

*Ueiifl before tlie I'liysichiii's Clul). :it :i. IcirKiiiet lield at the Sliernian House Api'il :J4lli, 
ISliti (by reiiuest). 



26 THE rLHXrs. 

ages has souofht to protect and foster this relationship by means 
of religious and legal enactments, but in doing so they have 
shoAvn too often their ignorance of the relationship itself and the 
limitations of their own abilities. 

In his "Intellectual Life," Hammerton says that "the subject 
of marriage generally is one of which men know less than they 
know of any other subject of universal interest." And yet per- 
haps no subject from the earliest times down, has been more 
legislated about. Had we a history of love, written by a Grote 
or a Gibbon, we would be able to trace more clearly the marriage 
thread running through the story and so acquire a better con- 
ception of the real nature and purpose of marriage. We would 
then realize how much of truth and how^ much of mere hyperbole 
are to be accorded to those sad words of Eloisa, ' 'Curse on all 
laws but those which love has made." 

It is said that three thousand marriages are contracted every 
day. When we recall the various matrimonial customs adopted 
by different nationalities, the immense number of laws in regard 
to marriage that have been inscrolled upon the statute books, 
the wide diversity of opinion in regard to the significance of the 
civil and religious rites of marriage, the question may very 
justly be asked in spite of its antiquity, what is the purpose of 
marriage y Legislators do not know, else there would be more 
of a uniformity than now exists in the marriage laws. Certainly 
the religious teachers are not clear upon the subject, else the 
churches would be more definite in regard to divorce. The phy- 
siologist studies only one of ""he results of marriage. The poet, 
the historian and the novelist relate only certain manifestations 
of the marriage relationship while their dicta are far from being 
authoritative upon these. 

The earliest authoritative statement in regard to the institu- 
tion and purpose of marriage is found in Genesis 
and runs thus: "And the Lord God said, 'it is 
not g(^od that the man should be alone; I will make 
him an helpmeet for him." When God thus created 
Eve as a helpmeet to Adam He laid the foundation, but only the 
foundation, of modern ujarriage. He created two complemental 
beings. He ordained that the one should be the delight and 
support of the other. And He clearly indicated that these two- 
beings should love and cling to each other until parted by death. 
In a burst of rapture Adam exclaimed then, "This turn hatK 



77//; rLKxrs. 27 

made amends; thou hast fulfilled Thy words, Creator bounteous 
and benign, Giver of all things fair, but fairest this of all tb}^ 
gifts, nor enviest. I now see bone of m}^ bone, flash of my flesh, 
myself before me; woman is her name, of man extracte:l: for this 
cause he shall forego father and mother, and to his wife adhere; 
and they shall be one flesh, one heart, one soul." Thus was the 
first marriage consummated. It was an ideal marriage, far 
removed from the mere union of the male and female of the 
animal world on the one hand and from the modern comi^licateJ 
artificial and law-begirt marriage on the other. The propagation 
of the species was a natural consequence of the union of our 
first parents but it was not the primary purpose of that union. 
And wdien this marriage took place it was not involved with any 
considerations in regard to titles, doweries, wealth or regula- 
tions in regard to the future progeny. There was no society to 
be protected, no ancestors to be cared for, no descendants to be 
remembered. The artificiality of the social organization had not 
yet arisen to mar the beauteous picture of this first simple i;lyllic 
marriage. Boasted civilization had not yet engulfed this happy 
pair in an inextricable maze of legal rights and privileges. 
They simply loved each other in body and mind and were en- 
dowed with a capacity for the most exalted devotion. 

Was this an ideal marriage^ If s > what was its purpose.-' 
The answer would seem to be too obvious for further-ccnsidtr- 
ation; but we hear from the lips of many estimable auu llnnkina: 
people that one of the primary objects of marriage is llio bereft - 
ing of offspring, the establishment of the fam ly. To th^s I would 
most emphatically say no. In the first place that is too low, too 
brutish a basis upon which to place the divine relationship of 
marriage. In the second place, there is nothing said about 
children in the institution of the first marriage and we have 
already accepted that as an ideal. In the third place, men and 
women do not marry primarily to have children unless per- 
chance now and then, Napoleon-like, they have political or finan- 
cial reasons for desiring an heir; but such a marriage is not a 
marriage in the truest sense of the word. It is the making use 
of marriage merely for a specific purpose. 

The begetting of children is a result and not the purpose of 
marriage. Polygamy, consanguineous unions and promiscuous 
intercourse do not materially modify the simple fact of re23ro- 
duction; hence if reproduction w^ere the primar}^ purpose of 



2^ THE PLEXUS. 

marriage, polygamy, consanguineous unions and promiscuous 
intercourse would be as legitimate and in some instances 
parhaps even more desirable than monogamy. Polygamy, 
jiolyandr}^ and jDromiscuous intercourse have been shown how- 
ever, to be most detrimental to the advancement of the race, not 
through the offspring but by reason of other factors. Before we 
can begin to conceive of the true purpose of marriage then we 
must away with the idea, sometimes taught in high places, that 
this divine institution is for the purpose of begetting a family. 
Once for all let it be clearly understood that the ideal marriage 
was instituted first and primarily for the happiness and mutual 
upbuilding of two sexually opposite individuals. Even the wel- 
fare of society, like the begetting of children, is of secondary 
consideration in the ideal marriage. 

"It's we two. it's we two for aye. 
All the world, and we two, and Heaven be our stay! 
Like H laverrock in the lift, sing-, O bonny bride. 
All the world was Adam once, with Eve by his side." 

Love, physiological or carnal love if you wish, is the basis 
of marriage, for there is no real marriage if the sexes are not 
oijposite. The refinement of this love which has been accom- 
plished only after long ages of upward struggling, has resulted 
in that higher conception of marriage as sung by Browning, 
Tennyson and Longfellow. From a Helen of Troy to an Evan- 
geline is a long stride but love, carnal love, is the small thread 
that binds these two together as sisters. Even the idealization 
of marriage so beautifully portrayed in the lives of the Brown- 
ings is founded upon sex. Sexuality then, let it be frankly 
admitted is the foundation of marriage as we know it to-day. 
The late Prof. Swing used to say that "it has been the dispo- 
sition and inmost genius of woman to make her attachments 
spiritual and eternal." So much the better for man but so long 
cis man is man and woman is woman, marriage will rest pri- 
marily upon sexuality. Upon this bedrock foundation a most 
beautiful and civine type of connubial affection has been erected, 
superstructure, like a magnificient cathedral, would totter 
and crumble to earth, did it not rest upon this strong and coarse 
foundation. To start with then we have sexuality as the basis 
of marriage, monogamy as its most favorable condition for 
perfect development of the love and happiness of the pair as its 
ultimate object. These are the elements in the purpose of 
marriage, so far as the mairied themselves are concerned. The 



TEE PLEXUS. 29 

resrlus of such a union, namely, the offspring, their character, 
their number, sex, etc., do not so immediately concern the 
II arried pair, but are, as it were, the sidework of God himself, 
who, in his inscrutable wisdom has deemed it best to hide from 
man the origin of life while ordaining that out of man's marriage 
the world should be peopled It seems as though the good 
Creator had said: "Man and woman love ye each other; lavish 
upon yourselves all the ai!'ection your physical and mental 
natures are capable of; love wisely and singly, for your own 
hajDpiness, you will see, will be thereby enhanced. If you do 
this, you will fulfill my law, my divine will; for I know that 
children will be borne unto you and that the more of purity, 
delicacy, and truth you exercise in your loves, the better will be 
the progeny to people my world." Such I take it was the 
original idea of marriage. 

Alas! however, the ideal is rarely attained. No sooner had 
the Garden of Eden been lost to man than marriage began to 
assume all sorts of strange forms and customs. The physical 
basis of marriage, its sexuality, ere long became so overwhel- 
mingly prominent that orientalism completely took possession 
of the human race. Without delaying to consider the gi-os.-; 
forms of polygamy and other manifestations of sexual exuber- 
ance characteristic of the ancient monarchies, not excepting 
even the Hebrew nation under David and Soloman, we discover 
that in fair and enlightened Greece woman was a jDlaythii g 
ratlier than a helpmeet to man. Helen is the type of the ideal 
Greek woman, but Helen was thought none the less of when she 
hastened with unbecoming speed to dwell for a time in the tents 
of rival warriors. Penelope, a paragon of wifely devotion was 
true to her absent Ulysses largely for political and mercenary 
reasons and in this she was neither in advance nor behind the 
period in which she lived. The early poets and dramatists all 
speak sneeringly or pityingly of womankind and thus voice the 
sentiment of their age. The flimsicalities of the women of 
Anacreon are hardly less edifying than the domestic broils of 
the women of Simonides Sappho, and be it to her credit as a 
woman, sings the earliest clear note of the singleness, intensity 
and permanence of ideal love. Asj^asia in spite of the discour- 
aging laws of Athens, remained true to Pericles who when 
dying, gratefully exclaimed "Athens entrusted her gi^eatness 
and Aspasia her happiness to me!" 



30 THE FLEX rs. 

From Aspasia to Messalina is a broad gap but e\'^en in 
debauched Rome there Avei'e true and devoted wives. The 
slavery of the ancient Avorld emphasized the sexual relationship 
of men and women and exerted a most deleterious eifect upon 
true marriage; for the slaves were not considered much above 
the animals and their procreation was a thing both politically and 
financially protitable. In the Middle Ages, chivalry upheld the 
cause of woman but as her sexuality with its accompaniments of 
tinsel and outward adornment was so greatly exalted, the 
chivalrous idea of marriage, though far in advance of the 
ancient, fell short of the highest conception of it. A Rabelais 
or a Boccaccio will depict for us the lot of woman in the 
unchivalrous masses of the age of Knights and Knighthood, and 
a lewd enough ^^icture it is. So gross became the sensuality 
amongst certain of the religious orders that most unusual laws 
and restrictions had to be made. With the collapse of these 
religious houses, the laws were taken ujd and promulgated by 
the state. Then marriage began to be so hemmed in and 
warped by statutory enactments that the mere accidentals of 
marriage such as property rights, titles, etc., rose into greater 
significance . than the love which was supposed to be the real 
basis of the marriage. If the state guaranteed the rights of 
primogeniture, the transference of wealth and the settlement of 
titles, what mattered it whether a couple a.bout to marry loved 
each other or not, so long as they were the possessors of these 
things, and their union confirmed and, enlarged their possessions. 
Therefore, when Catherine, the widow of Henry V married the 
Welsh soldier, Owen Tudor, the world stood aghast but nodded its 
head in I'aptajjproval of the mercenary marriage of the Duchess of 
Norfolk, a bride of some eighty-two summers with the brother- 
in-law of Edward IV, a bachelor of twenty. Marriage under the 
fostering care of the state came to be largely a means of 
aggrandizement. Property interests, family connections and all 
sorts and conditions of affairs were made the raison-d'etre of a 
wedding rather than the love of man for woman. To-day we 
are not as sensual as our ancient ancestors but we are still 
somewhat prone to barter our love for gold and broad lands. 
We do this because the marriage laws guarantee us their pos- 
session. The simple, ideal marriage, based upon mutual love 
and love only, if not nullified is at least not encouraged by its 
regulation by the state. This regulation of marital sicle-isssue 



THE PLEXUS. 31 

leads too often to ill-mated unions. Unhappiness, discontent, 
and even disease result and the progeny quickly becomes 
degenerate. Men and women are Jiot cattle to be bred upon the 
stud- farm principle. Even the welfare of society would not be 
increased for so long as marriage is founded upon sexuality and 
the mere accompaniments of marriage such as the birth of 
children, the establishment of property rights, etc , too much 
regulation of the marriage relationship will foster clandestine 
intercourse and the production of artificial abortion. It is a fact 
that in proportion to the heightened state of civilization with all 
its accompaniments of physical luxury and legal safeguards 
into which man rises, clandestine intercourse and artificial 
abortion become frequent. History has demonstrated this over 
and over again and to-day our complicated marriages are with 
out doubt largely responsible for the prostitution, adultery 
and abortion which are so rampant and which we so bitterly 
deplore. 

The complications of modern marriages are very largely the 
result of outside interference through the church and state. 
Men and women too often lose sight of the primitive purpose of 
marriage and unite to avail themselves of the advantages or to 
a\'oid the penalties, conferred upon the marriage state by the 
chuiT'h and the laws. If these advantages or penalties were 
kept at a minimum there would be that much less of an induce- 
ment for men and women to marry excej^t for love, true love, 
arid as a consequence the ideal marriage would be more of an 
accomplished reality. It seems to me therefore, that the pri- 
mary purpose of marriage as I have tried to indicate it, and the 
unfortunate results that- follow when it is rendered too compli- 
cated, both declare in no uncertain tones that the law had better 
leave so private, so delicate a relationship alone. It is not my 
province to sjieak of the protection of society and the oifspring 
but I am convinced that the procreation of defectives can be 
controlled by other means, compulsory treatment, registration 
and segregation, more effectively and to the betterment of so- 
ciety than by any prevention or direct regulation of the marriage 
custom. Let the ideal marriage be encouraged by educating the 
people from the pulpit and the rostrum. Let it not be harassed 
and complicated by laws and statutes concocted by erring man- 
kind. God and nature b^^ causing sterility, submersion of the 
incompetents and the failure of defectives to survive in the 



8:2 THE PLEXUS. 

struggle for existence will amply protect society, if society does 
not interfere and set up barriers to the ideal marriage, the 
marriage for love and love only, true love, the love that "awaits 
a truer unfolding in opposition and rebuke to that subterranean 
prudence which presides at marriages with words that take hold 
of the upper w^orld whilst one eye is eternally boring down into 
the cellar, so that its gravest discourse has ever a slight savor 
of hams and powdering-tubs." 

Emerson says a "statue is beautiful when it begins to be 
incomprehensible, when it is passing out of criticism and can no 
longer be defined by compass and measuring wand, but demands 
an active imagination to go with it, and to say what it is in the 
act of doing/' So, it seems to me, is true marriage, beautiful 
because mysterious. In Holy Writ it is the favorite metaphore 
of heavenly relationships. It is the only arena for the expression 
of man's finest emotions and the development of his loftiest 
ideals. It is the earthly manifestation of celestial love, a scintil- 
lation from the very foot of the throne of God. Heaven is heaven 
because of love, marriage is marriage for the same reason. 
With the poet then let us sing: 

'•The tivasures of the deep are not so precious 

As are the concealed comforts of a man 

Lock'd up in woman's love. I scent the air 

Of blessings, when I come but near the house. 

What a delicious breath marriage sends for;,h — 

The violet bed's not sweeter!" 

KKi State street. 



^lipiGol lOeparbrpepb. 

COLLEGE OP PHYSICIANS AND SURGEONS. 
E. A. Gansel. 

Whatever weakness there may be in the theoretical work of 
the fourth year course of the spring term is certainly well made 
up for by the abundance and variety of clinical material pre- 
sented by the different members of our faculty. 

The clinics at both the College and the County Hosj^ital 
have been large and interesting. The students who are for- 
tunate enough to be able to take the spring course are getting a 
line of practical work such as is seldom obtained by students 
attending college. While there are not as many students as 
there were during the winter term, the clinical material is more 



THE PLEXUS. 38 

abundant and the students are thereby enabled to come into 
closer contact with the patients and their ailments. 

The number of patients at the dispensary is also increasing 
and in some of the rooms excellent work is beino: done. 

Promptly on the first Friday A. M. of the spring term Prof. 
Murphy met his new Seniors and after a short inspection singled 
out a man who for the first time in his college course was 
entitled to a seat in the front row. This man was soon plunged 
into the mysteries of osteomyelitis and it wasn't long before 
quite a number of us were doing some very hard thinking. 
Soon after some of the gentlemen were asked to come down and 
then the real work began. 

Among the many cases which Prof. Murphy has presented 
during the past month are the following: Recto- vaginal fistula, 
tuberculosis of the hip-joint, hernia following traumatism, tuber- 
culosis of knee-joint, fracture of shaft of femur and fracture of 
pelvis, sarcoma of omentum, fibro- sarcoma of cheek, brain 
syphilis, dislocation of the shoulder joint, Schroeder's trach- 
elorrhaphy, and a very severe case of septic peritonitis. 

Prof. Lee performed an operation for complete ampution of 
the penis and removal of inguinal glands for epithelioma. He 
also showed a Pirogoif's amputation, bullet wound of the abdo- 
men and a case of spontaneous fracture of the femur due to 
sarcora a 

Prof. Newman has presented a large number of cases show- 
ing different degrees of perineal and cervical lacerations and has 
given many practical points on treatment of same. 

Prof. King showed a case of spastic paralysis, a case of atyp- 
ical anterior poliomyelitis, and several cases of brain syphilis. 

Prof. Steele operated on a recurring appendicitis, empyema, 
fibro sarcoma and a keloid besides jDresenting numerous interest- 
ing cases for diagnosis. 

Prof. Davis operated on an empyema and resected a tubercu- 
lar knee-joint. 

Profs. Harsha and O'Byrne removed a large cyst of the 
broad ligament, performed a craniectomy besides doing a num- 
ber of minor operations. 

Prof. Gamble, by his careful selection and presentation of 
clinical work, is making ophthalmology a very interesting study. 
He has presented cases of catarrhal conjunctivitis, granular con- 
junctivitis, corneal ulcer, idiopathic iritis, syphilitic iritis with 
posterior synechia, and dacryocystitis. 



Aluippi IjepcirtiTienh. 

Dr. Louis J. Mitchell, Editor. 

April 17, "yy. 

The 17th annual meeting of the P. & S. Alumni Association 
was held in the club room of the Briggs House. Owing to the 
absence of the President the meeting was called to order by the 
Secretary pro tem. 

The Secretary not being present the reading of minutes was 
dispensed with. 

ELECTION OF OFFICERS. 

For President,.— Dr. A. M. Harvey, "93, and Dr. O. Dodd, '9!), 
were nominated. Dr. Dodd received eight votes, Dr. Harvey ten 
and was declared elected. 

Fur Vice- President. —Br. S. M. Strohecker, '99, and Dr. W. C. 
Abaly, '86, were nominated. Dr. Abaly received nine votes, 
Dr. Strohecker thirteen votes and was 'declared elected. 

For Seei etarii-Trensu rer.—'Dv. W. Gus Evans, B. S., M. D.,'99, 
late of Aberdeen, Miss., and later of Chicago was elected by 
acclamation. 

Executive Board. — Dr W. C. Abaly, '^6 was elected a member 
of the Executive Board for the term of five years. 

The relations of the Association to the college paper were 
discussed and after remarks by various members the following 
motions were moved and carried. "That a bill for ii^l. 25 be sent 
out in the name of the Association instead of the Plexus, $1.00 
to go to the Plexus and 25 cents to the Association." also, 
"That a committee from the Alumni Association on the relations 
of the Plexus and the Association, looking to a financial ar- 
rano-ement between the Plexus and the Association'' The 
chair named as this committee Drs. Evans, Mitchell and Wesener. 

It was moved and carried ' 'That the nature of the entertain- 
ment next year be left to the Executive Committee. 

Dr. A. Gehrman then demonstrated the Widal test and Dr. 
.J. A. Wesener made some remarks on the secretion of hydro- 
chloric acid in the stomach. 

The meeting then adjourned. 

Twenty-eight members were present. 

Louis J. Mitchell, Secretary pro tempore. 



THE PLEXUS. 35 

"85. Dr. Oscar Fordyce writes from Guthrie Center, Iowa: 
"Am at the same old stand. No kick coming and running to 
seed a little on surgery. 

"86. Dr. N. H. Henderson is erecting a large addition to his 
private hospital (The Lakeside, 4147 Lake avenue, Chicago). It 
will be completed by Aug. 1 and there will be room for seventy 
patients and thirty nurses, with a line new operating room and 
elevator service. 

"87. Dr. G. J. Kaumheimer, of 508 Third street, Milwaukee, 
states that it is his firm conviction that the last number of the 
Plexus is a great improvement on its "pordecessors. "' He states 
also that each number puts him back about twelve years in age. 
At this rate he will soon feel pretty antiquated. 

'd^S. Dr. D. Baldwin Wylie, who has been associated with 
Dr. Jos. Schneider for several years has opened an office in 
Rooms 30--3 Empire Bldg., Milwaukee, Wis. He is confining his 
practice to diseases of the eye and ear and rej^orts business quite 
good. 

"88. Dr. W. F. Malone, also of Milwaukee, is said to be doing 
a fine business and ranks among the leaders in the faculty of the 
Milwaukee Medical College. The Doctor has taken a large house 
at 333 Greenbusch street, and furnished it beautifully through- 
out. Though it looks very suspicious he denies all intention of 
making anything other than bachelor quarters of the place. 

'92. Dr. F. R. Smyth, of Bismarck, N. Dak,, who is presi- 
dent of the State Medical Society was burned out last August in 
the fire which nearly destroyed the town. To prevent similar 
catastrophies he has gotten married and started housekeeping. 
The doctor suggests that the Alumni be given a certificate of 
membership in Latin. This is a seasonable suggestion and as 
soon as the snake editor returns from his vacation he will be set 
to work composing one. 

"93. Dr. J. S. Kilbride, who has been enjoying a good prac- 
tice at Sleepy Eye, Minn. , for the past year and a half announces 
the arrival of a boy at his home. The Doctor sends greetings to 
the class of '93. 

'93. Dr. W. F. Fee has recently moved from Williamsburg, to 
Meade, Kan. He is doing well in his new location and would like 
to hear from his classmates. 



"36 THE PLEXUS. 

'95. Dr. Jesse McClain is one of the few P. & S. graduates 
located in Ohio. He is doing a good business in Coshocton, a 
town of 6000 with 15 doctors. He suggests a reunion of his class 
at the '00 meeting. 

"95. Dr. C. H. Le Due, of Danbury, la., as is usual with the 
alumni, reports a well paying practice and is enjoying life even 
with the manj^ trials and tribulations for a doctor. The Doctor 
had a successful operation for appendicitis recently. 

'9S. Dr. A. V. Simpson has finished his term of service as 
interne in the Lakeside Hospital and returns to his home in 
Rosemond, Ills. , for a short time after wiiich he will spend the 
.summer in the East. 

'98. Dr. A. W. Fuson, of La Paz, Ind., visited the school 
recently and rejDorts that he is kei:)t busy. 

'99. A postal card addressed as follows: 
Miss Lizzie Hee'an, 
813 W. Harris 311 St., 

Chicao-o. 

has written upon its reverse side the following: 

Piper City, 111., 4— ,5— '99. 

Dr. Rhinehardt died this morning at Roberts, 111., near here, 
and leaves a good opening for one of our boys. Please post and 
oblige. Am in the country, much flowers, much .sleep, much 
time, much obliged. Yours truly, 

"Dutch Y." 

The w^ording of the above sounds familiar, but not so the 
name. Wonder if it could be Tiek '99. 

'95. Dr. P. S. Diller, of Roberts, 111., wiio is a good man 
will no doubt take care of all of Dr. Rhinehardt's practice (refer- 
ing to above). Dr. Diller brought in a patient recently who was 
suffering from appendicitis. Dr. Steele operated on this patient 
May 11th last. Dr. Diller also reports the following case: 

Mrs. Eva S. , age 17, had typhoid in '97, family history neg- 
-ative. Without money and under distressed circumstances she 

left F , 111., to walk to R , 111., a distance of 

forty-five miles, carrying a large grip containing her belongingSw 
After traveling a coui:)le of days she became ill, but struggled on 
until she became entirely exhausted, when she took refuge under 
a bridge where she was overcome with pain. She remained 
there^for two or three days without anything to eat and was then 
delivered of a. child. 1 She became unconscious and completely 



THE PLEXUS. 37 

lost all record of the following two or three days. 
She thinks the child was about four days old when 
she pulled cord off because as she said "itbegan to 
stink." She then resumed her journey with babe and 
grip. Ate no food because she was not hungry. Saw patient 
first on the 8th day of April, (after birth of child. ) Saw her again 
on April 24, when she stated that while at stool something passed 
from her and fell into the vault of closet. This was evidently 
the placenta which had been retained during all this time.- Tem- 
peratui'e, 99^° F. The babe, although prematurely born, seems 
to be quite healthy. Mother suffering very much. 

There is going to be a pretty warm time at the next annual 
meeting of the Alumni Association. 

Take due notice, all ye that contemplate attending, and i^re- 
pare for a time such as you have not had for many a day. 

At the last annual meeting held at the Briggs House, April 
17th, 1899, this question came up, "What can be done to arouse 
the enthusiasm and interest of the alumni of the P. & S." 

The President, Dr. A, M. Harvey, '93, announced that sug- 
gestions were in order. Immediately upon the heels of this an- 
nouncement Dr. J. A. Wesener, "94, obtained the floor and sug- 
gested the following: "Mr. Bresident; In as mudch as ve haf 
sciendific dings enough alretty in unser effery day bractice I tink 
dat it vos ^besser dat ve a liddle more zum trinken und essen 
haben at unser nechte meeding. I tink dat ven ve haf a big keg 
off beer in der middle und ve ail sit him around mit a grosze 
stein in unser handt und limburger Kase mit roggenbrodt, dat, 
dat vill der endusiasm bring oud. Let uns a regular salamander 
have. Dere's nodings like beer to make dings lifely." At this 
point Dr. W. A. Evans, '85, woke up (the word "beer" did it) and 
asked to be informed as to the nationality of the distinguished 
gentleman making the suggestion. He was informed that he was 
an Irishman. Dr. A. J. Behrendt, "91, another Irishman, asked 
to be recognized and the President granted him recognition. He 
seconded Dr. Wesener s motion and asked that the following 
amendment be inserted. — "That instead of having only one keg 
of beer the members of the association then present appoint a 
committee to select a suitable place where there was a chance of 
securing more beer und dings to eat if one keg was not enuf and 
der roggen brodt und limburger gave out. This was greeted 
with a noisy applause. Remarks were then in order. 



38 THE PLEXUS. 

Dr. Frank B. Earle, "85, then secured the lloor and made the 
speech of the evening. He said, "Mr, President and Gentlemen, 
I agree most heartily to the motion of Dr. Wesener and the 
amendment of Dr. Behrendt, and if the motion is carried into 
effect we will have the joUiest of jolly times, I remember that 
once I was one of a party, and we went out for a time and went 
to just such a place as Dr. Behrendt suggests. Well of all the 
times. Say! Where did we go? Let me think. Well sir, I for- 
get. 1 knew where we were when we went in but I'll be horn 
swoggled if I know where we were when we came out. But I 
never had such a time in all my life. Never had such a gol darn 
time.'' 

Just then a very peculiar buzzing sound was heard over in 
one corner of the room. It grew louder and louder and finaly 
Dr. Evans arose and informed the assembly that during the dis- 
cussion he had evolved a plan in his mind (this accounted for 
the buzzing noise as of wheels going round) and with their per- 
mission he would continue evolving this plan and have it per- 
fected at the next annual meeting. Dr. L. J. Mitchell, '86, inter- 
rupted him by shouting, "Here! not so loud please!'' (Dr. Mitchell 
was sore at Dr. Evans because Dr. Evans was elected secretary 
of the association and not he) but Dr. Evans was not phazed in 
the least, merely said he was pleased to know that Dr. Mitchell 
could hear his mind evolving. (Goodness, everybody heard it.) 

Dr. John Fisher, '87, here stuck in his lip and stopped the 
fracas and said he was exceedingly glad to know that Dr. Evans 
mind was in working order and capable of doing at least some- 
in the way of evolution. For no one would suspect such a thing 
by the looks of him. Dr. Evans looked as though he would fight 
at this slighting remark, but Dr. C. F. Stoltz, '93, of South Bend, 
settled the affair, which was becoming personal, by suggesting 
that the matter be placed in the hands of Dr. Evans, the newly 
elected secretary, to arrange for the entertainment for next year 
and if you want a good time you'd better come. 



LIBRARY NOTES. 
Grace W. Bryant, Librarian. 

The library has received a notable gift from Washington, 
D. C. this last month, and. one which it has taken some effort to 
obtain, viz: The Index-Catalogue to the vSurgeon — General's 
Library. This is a voluminous work consisting not alone of an 
alphabetical arrangement of author /ind subject titles of each 
volume in the Library, but also subject- titles of pamphlets and 
periodical ai tides. As the Surgeon-General's Library contains 
123,924 volumes, 210,151 pamphlets, and 3,225 periodicals, it is 
clearly seen that practically all the medical literature of the 
United States, and a great deal besides is indexed in these 
volumes. The value of having all periodical articles indexed is 
inestimable to the reference work in a library, especially in one 
of limited resources. But three volumes of the new series have 
been published, each volume representing respectively the 
literature listed under the first three letters of the alphabet. 
Our Library is to receive each volume as it is published. 

The following articles from members of the Faculty have 
been noted in the journals during the last month: 

Dr. 'Carl Beck, "Value of the resection of the sympathetic 
ganglia of the neck in the cure of epilepsy," Clncago Medical 
Recorder, April 1S99, p. 279. Dr. L. J. Mitchell and E. R. 
Le Count, "Report of a necropsy in a case of acromegaly." 
N. Y. Med. Jour. April 15, 29, 1899, p. 517, 595. 

Dr. W. E. Quiue, "The medical profession — causes of its 
division into discordant elements, and the reason I am not a 
homeopath." Jour, of Amer. Med. Assn. April 29, 1899 p. 903 
May 6, 1899 p- 980. 

NEW BOOKS. 

Amer. Pediatric Soc. — Transactions, 1898. Society, donor. 

Amer. Public Health Ass'n. Bertillon classification of 
causes of death, 1899. Ass'n. donor. 

Byford, H. T.— Manual of gynaecology, Ed. 2, 1897. Dr. 
H. T. Byford, donor. 

Cohen, J. S. — Diseases of the throat and nasal passages, Ed. 
2, 1879. Dr. W. L. Ballenger, donor. 



40 THE PLEXUS, 

Cornell, F. G. — Intestinal sutures; some old and some not so 
old, and a new one. (Essay receiving- the second prize in the 
Dep't. of Surgery of the Philadelphia Med. Jour. Prize contest of 
Jan. 1899). Dr. F. G. Connell, donor. 

Davis, J. R. A.— Textbook of biology, 1888. Dr. L. J. 
Mitchell, donor. 

Dorland, W. A. N.— Manual of obstetrics, 1896. Dr. F. B. 
Earle, donor. 

Fothergill, W. E.— Manual of midwifery, 1886. Dr. F. B. 
Earle, donor. 

Galabin, A. L.— Manual of midwifery, 1889. Dr. F. B. 
Earle, donor. 

Hudson W. H.— Sea-sickness, 1883. Dr. W. L. Ballenger, 
donor. 

Huxley, J. H. and Martin, H. N.— Practical biology, 1888. 
Dr. J. L. Mitchell, donor. 

Illinois, — Health Board of — Aj)pendix to 20th annual report, 
1898. Board, donor. 

Indiana state medical soc. — Transactions 5 V, 1886-91. Dr* 
"VV. L. Ballenger, donor. 

Jewett, Chas.— Essentials of obstetrics, 1897. Dr. F. B. 
Earle, donor. 

N. Y. Juvenile Asylum. 47th report, 1898. Governors, donor. 

The Observer, 2 V, 1894-95. Dr. L. J. Mitchell, donor. 

Reed & Noyes. — Quiz manual of histology, 1897. Dr. W. L. 
Ballenger, donor. 

Remington, J. P. — Practice of pharmacy, Ed. 2, 1890. Dr. 
B. Fantus, donor. 

R. I.— Health Board of,— 19th annual report, 1898. Board, 
donor. 

Sajous, C. E. — Di.seases of nose and throat, 1sm6. Dr. W. L. 
Ballenger, donor. 

Sutton, J. B. — Evolution and disease, 1892. Dr. L. J. 

-. -. "^^ ^''i^'^^.^tal service. — Weekly jiublic health re- 

ports, lS98-;:,,i, V^ol. _L_, ,• J. Gov't, donor. 

U. S. Surgeon-Gen. Office. — Index-catalogue to Surgeon- 
General's Library; V, 1-3. Govt, donor. 

U. S. War Dep't — Annual report of Surgeon-General, 1898. 
Gov't, donor. 

Virchow, Rudolph. — Post-mortem examinations, 1891. Dr. 
L. J. Mitchell, donor. 

Ii>'prints atuj Jourmils. 

Dr. J. B. Murphy. — 11 reprints. 

Dr. Rosa Engelmann. — Box of reprints, journals and reports. 

Dr. L. J. Miif'hell. — Journals and reprints. 




WELLEK VAN HOOK. A. B., M. D. 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 

UNIVERSITY OF ILLINOIS, 



VOL. V. JUNE 20th, 1899. NO. 2. 



THE RFSULTS OF WIDAL'S TEST IN THE DIAG- 
NOSIS OF TYPHOID FEVER FROM DRIED 
BLOOD SPECIMENS. 
By Adolph Gehrmann, M. D. 

Professor of Bacteriology, College of Physicians and Surgeons, Chicago. 

The use of dried blood as a means of collecting and preserv- 
ing specimens of blood for the diagnosis of typhoid fever, first 
suggested by Wyatt Johnston in 1896, has been generally used 
by health authorities as a means of diagnosis since that time. It 
has been subject to some modifications, but as used in most places 
it is essentially the same method originally proposed by Dr. 
Johnston. 

In Europe dried blood is seldom examined — at least, pub- 
lished statements of this use are not to be found. Indeed, 
Widal's test has been more widely adopted as a public health 
diagnosis in America and England than it has been on the Con- 
tinent, and in the United States and Canada it has been used to 
especial advantage. 

The chief objection to the use of the dried blood specimen 
is the inability to obtain accurate dilutions, but it may also be 
said that all of the other methods of applying the Widal test 
require considerable skill for the collection of the serum and the 
measurement of the dilution, making them, therefore, too com- 
plicated for utility in public laboratories. 

The most accurate and reliable examinations are those in 
which, in addition to the other details of technique, some cog- 



42 THE PLEXUS. 

nizaiice of the reaction, as related to the degree of dilution, is 
taken. In developing the dried blood method various attempts 
have been made to procure a measured amount of blood at the 
time of collecting the specimen. The use of the platinum loop, 
by which drops are collected and deposited separately upon 
paper or glass and then dried, has been extensively tried. 
These dried drops of blood are then units to be followed in mak- 
ing the series of dilutions. We have found in using the platinum 
loop in this way that there is a possibility of considerable varia- 
tion in the size of the drop. For instance, the loop may be filled 
evenly from side to side, or the drop may be almost spherical, 
bulging out from the Ioojd, and the quantity contained may then 
be two or three times what it would i e if the loop were simply 
evenly filled. Another method is that in which cai^illary tubes, 
as proposed by McFarland (1), are filled with blood which is 
allowed to dry in the tube. The capacity of the tube is known 
and is used as a unit, and the dilution is made by crushing the 
glass in a mortar with a measured quantity of culture or water. 
In another method the blood is dried and weighed and the dilu- 
tion calculated from the weight. This method is now used by 
the Baltimore Health Department. The chief danger in this 
procedure is that the serum will separate in drops from the clot 
that forms, and in weighing one may have a greater weight of 
corpuscles than if the entire mass of blood had dried evenly. 
When every particle of the dried specimen can be weighed the 
estimation by this method is very accurate. Considerable bloOd 
is also required in order to make weighings. No scheme yet 
l^roposed has supplied an easy way of obtaining a definite 
quantity of the dried blood at once exact and suitable for the 
skill of everyone. But, like many technical operations, serum 
diagnosis requires that operators have a thorough acquaintance 
with the method used. The same result may be obtained by 
other observers working in another way. 

Biberstein (2) has recently deprecated the dried blood 
method as impracticable, saying that as the agglutinating sub- 
stance exists only in the plasma or serum, and as the volume of 
corpuscles in a given unit of blood, especially in pathological 
conditions, varies in a marked degree it is impossible to procure 
an accurate unit from which to estimate the dilutions when the 
corpuscles are present. Further, he holds that the use of atten- 
uated cultures does not facilitate the diagnosis in the dried blood 



I\esults of WidaVs Test. — GeJniiian. 43 

method. The value of the different methois of conducting the 
diagnosis can only be determined by the results of a large num- 
ber of examinations. If such examinations cannot, in the main, 
be shown to be correct, we will have to agree with Kiihnan (3), 
who concludes that the serum diagnosis requires an exact labor- 
atory study, in which form it is not suitable for general practice. 
The deductions from the examination of Johnson (4), Bloch (5), 
Stewart (6), Wesbrook and Wilson, and our own S3ri:s of 109 
previously reported results, does not seem to warrant such a 
limited application. Stewart found in 1,000 tests made in Phila- 
delphia 969 cases correctly diagnosed. In the thirty-one failures 
reported the reaction was present three times in cases that were 
not diagnosed as typhoid, while in twenty-eight it was absent in 
cases that subsequently proved to be typhoid. In our own series 
of 109 examinations in 1<S1»6 the test failed in seven instances, the 
reaction being observed in live cases that were not typhoid and 
being absent in two instances when typhoid was diagnosed. 
Two of the five cases mentioned, however, presented undoubted 
histories of having previously had an attack of typhoid fever. 
The reports of most observers seem to indicate the possibility of 
a small percentage of failures in making a positive diagnosis, 
even among those depending entirely upon the examination of 
the serum, as Comba, Ziemke, Stern and Courmont. They have 
made "the most careful dilutions in series for the different cases 
that tliey have examined. Whatever method is used the failures 
are due to the absence of the agglutinating substance during the 
first days of the disease, and, on the other hand, to the presence 
of an unusually strong, normal agglutinating substance. 

In regard to the influence of a previous attack of typhoid 
upon the test, opinions are now giving it less importance, be- 
cause it has been found by repeated tests after typhoid that the 
real reaction of the disease disappears in adults during the first 
six months after convalescence and in children somewhat more 
quickly. Courmont (7). That the reaction does not occur early 
will be discussed later. 

It is admitted that the careful determination of the limits of 
the reaction — that is, the dilution in which the normal agglutin- 
ating substance is still active — and the degree of dilution in 
which the specific substance can be shown to be effective in cases 
of typhoid must be differentiated. The experiments of Stern (8), 
Sklower and Biberstein (2) have fairly demonstrated that a dilu- 



44 THE PLEXUS. 

tion of serum 1:5(» entirely removes the danger of observing a 
normal or pseudo-reaction. As the specific reaction is marked 
in dilutions much beyond this, it would seem that all danger of 
mistakes from this cause could be entirely avoided by sufficiently 
diluting the blood or serum in applying the test. The observa- 
tion of the limits of the effectiveness of dilutions in producing 
agglutination is of value in following the progress of a given 
case, but for the purposes of diagnosis it is simply desired to 
establish either the presence or the absence of the phenomenon. 
The methods used in the diagnosis of typhoid in the laboratory 
of the department are the same as those described by Wynekoop 
in the Biennial Report of 1895-96. The specimens of blood are 
obtained without any special reference to the quantity, it being 
requested simply that enough blood be sent. The cultures that 
are used are bouillon cultures made from ftock cultures on agar. 
These bouillion cultures are grown at room temperature and are 
used during a period of twenty-four to fifty hours after being 
planted. The stock cultures are also grown at room tempera- 
ture. In this way typhoid bacilli are obtained that are not very 
actively motile, but still are always evenly distributed in the 
bouillon and show great uniformity in their motility. 

In making the test the dried blood is dissolved in distilled 
water and enough water is used to give what would be considered 
a dilution of from one to fifteen or twenty. It is, however, an 
estimate and not an accurate dilution. After allowing the water 
and blood mixture to stand a few moments, so that particles may 
settle, a drop is taken with the platinum loop from the top and 
mixed with an equal-sized drop of bouillon culture. This is 
placed upon a cover glass in a hanging drop preparation for 
microscopic examination. It has been found that the amount of 
color in the drop is of considerable value in determining whether 
sufficient dilution is present, and from our experience this is 
taken into account. The dilution in the first examination is 
about one to thirty or forty. 

In cases where the reaction seems to be unusually prompt 
the original mixture of blood and water is diluted with a drop of 
distilled water — one drop of the mixture and one drop of dis- 
tilled water — and this is again mixed with the culture and exam- 
ined, thus making a further dilution. In typical cases dilutions 
may be carried on in this manner three or four times before the 
reaction disappears The time of observation is continued to six 



Results: of Widal's Test. — (ielirman. 45 

hours before it is positively reported that no reaction is present. 
The specimens remain at a room temperature, but most of the 
cases showing the reaction are decided in two hours. 

In some special cases the dried blood and mica slip is 
weighed, the blood scraped into a watch crystal and the piece of 
mica again weighed; the difference in w^eight representing the 
blood solids or about twenty per cent, of the original weight of 
blood. Distilled water to replace the blood water is added and 
dilutions are made by adding more water in the proportions 
desired. It has been found that at least five milligrams of dried 
blood are required. This amount can be obtained from five large- 
sized drops of blood, A pipette graduated in hundredths of a 
cubic centimeter is used for measuring the water or culture in 
making these dilutions. Prof. Klebs has suggested that all the 
examinations be made in this way, but so far this does not ap- 
pear to be an imperative necessity. 

During 1898 there were received at the laboratory of the 
Health Department 715 specimens from suspected typhoids. 
After some time a letter was sent to the physicians who had sent 
in the specimens, requesting that they return their opinions as 
to the final diagnosis or outcome of the cases from the observa- 
tion of the subsequent clinical course. Five hundred and seventy 
such replies were received and tabulated with the original date 
of the blanks accomjDanying the specimens and with the results 
of t>he tests made with the specimens. The general summary of 
this tabulation shows the following results: 

715 cases examined. 
570 clinical reports returned. 
145 clinical reports not returned. 

353 reports of occurrence of typhoid reaction were sent. 
362 reports of absence of typhoid reaction were sent. 
Cases in which typhoid reaction occurred (353): 
23 2 diagnosed clinically as typhoid. 
93 cases not clinically reported. 
23 cases not diagnosed as typhoid. 
5 cases passing from observation. 
Cases in which typhoid reaction was absent (362): 
50 cases diagnosed clinically as typhoid. 
132 cases not clinically reported. 
176 cases diagnosed as other conditions. 

4 cases passed from observation. 
408 correct diagnoses. 
73 failures in diaanoses. 



'^6 THE PLEXUS. 

The number of times the results have failed to correspond 
Avith the clinical reports is large and should not be taken as evi- 
dence of the actual value of the test. These figures deserve 
some explanation. 

These results are not the results of the examination of 715 
patients, but the simple results of so many tests. From some 
of the cases reported specimens were sent in several times, and, 
as will be shown, there is reason for the elimination of a number 
of other failures. 

The cases in which the reaction was present, but which were 
diagnosed as not typhoid, have the following causes assigned for 
the sickness: 

Acute perihepatitis — partial reaction. 1 case. 

Subacute iudigestion, 2 cases. 

Autointoxic-ition, slight uremia in one. 4 cases. 

Cases well 3 to 4 days after examination, 2 cases. 

Acute enteric catarrh, 4 cases. 

Intiuenza, 2 cases. 

Cerebrospinal meningitis, 2 cases. 

Malaria, 3 cases. 

Enteritis, 2 cases. 
In two of these there were records of a previous attack of 
typhoid. In thirteen of them there was evidence of some intes- 
tinal disturbance, as shown by the symptoms enumerated in the 
blanks accompanying the specimens. However, they cannot be 
explained by offering a doubt as to the diagnosis. We have con- 
cluded that they are instances of unusually developed normal 
agglutinating power. 

These twenty-three patients were all over twenty years of 
age except two, where recovery occurred in two-three days, and 
one of those where the diagnosis of enteritis was returned: this 
was a child six years of age. 

The fifty cases where the reaction was absent may be divided 
into several groups. Eighteen cases seem to be complete fail- 
ures, as the examinations were made after the first week of sick- 
ness, but there were no re-examinations. 

Thirty-two cases were patients who had not been sick an 
entire week when the blood specimens were taken. 

Twelve cases were re-examined and the reaction obtained 
with the later specimen; in one instance the reaction was absent 
the sixth, but present the eleventh day; another was absent the 
sixth, but present the fifteen day; another absent the eighth, but 



Results of Widid's Test. — GehniKin. 47 

present the ninth day; and in one of them it was absent the 
t^velfth day, but was found on the fourteenth day. 

There is a possible explanation for two cases in that an ~ 
interval of five days in one and six days in the other occurred 
between taking the specimen and applying the test. The agglut- 
inating power of dried serum is lost after a time and the speci- 
mens may not have been under favorable conditions to retain 
this i^ower. 

In five other cases the blood specimen was too small for a 
satisfactory test. 

Among the thirty-two cases from which the blood specimen 
was obtained during the first w^eek are three of those in which 
the blood specimen was small and the two cases in which the 
examination was delayed; the other two were not in this group. 
It is possible, then, that thirty-two failures can be explained, 
but sixteen remained for which there seems to be no explanation. 
Adding these sixteen to the twenty-one cases of failure in which 
the reaction was observed, and where previous typhoid was 
absent, there are thirty-seven failures in 481 examinations, where 
the clinical reports are of value, or 3.32 per cent, of failures. 

Further, it is noted that in the group of failures there are 
three cases of tyj^hoid and pneumonia. The effect upon the 
reaction in complicated cases of typhoid has not been fully 
studied. Complications are reported in seven cases in the series 
that were correctly diagnosed; pneumonia, nephritis, tubercu- 
losis and malaria w^ere noted. Ziemke (9) reports cases of pneu- 
monia and tuberculosis where the complicating conditions did 
not prevent the reaction. It is probable, then, that the failure 
in these cases is not due to the presence of a complication. 

As regards the value of the test in typhoid it has been sho'vn 
by numerous published reports of examinations that the results 
are uniformly positive in w^ell-marked cases of typhoid. If the 
possible causes of failure, namely: The short duration of the 
sickness at the time of examination and the absence of a previ- 
ous attack of typhoid, can be eliminated, the test becomes an 
absolute sign. Under general circumstances, however, a single 
test is simply presumptive evidence. It is clearly not an early 
sign, no earlier in most cases than the recognized symptoms of 
typhoid. Frequently, however, the reaction is found early, but 
in these cases it is sometimes difficult to decide as to the real 
time of beginning of the sickness, as happens in those patients 



48 THE PLEXUS. 

called walking- typhoids. The re-examination is evidently a 
hig-hly important part of the test and is the only way to increase 
its reliabilit3^ Ziemke (9) reports a case of absence of the reac- 
tion on the eighth day, but present on the tenth. Biberstein 
reports the test made on verified typhoid patients: Eight ex- 
aminations the first week, with two failures, and thirty-two 
examinations the second Aveek, with four failures. 

One case was negative at the first examination, made during 
the first week, and also negative for the second examination, 
made the eleventh day, but the reaction was obtained at the 
third, on the eighteenth day. Another case was negative on the 
ninth and fourteenth days, but positive on the nineteenth day. 
These results, which are similar to our own, go to prove the 
value of re-examinations. In the series of cases showing clinic- 
ally as tyx^hoid some had the reaction early; one on the second, 
eight on the third, four on the fourth, and three on the fifth day. 

In the examination of cases that are not typhoid the absence 
of the reaction during the first week is only presumptive evi- 
dence. Bloch and Bates (5) suggest that those cases in which 
the test is absent on the tenth day of the sickness should be 
regarded as not typhoid. Among the failures in obtaining the 
reaction in our series of examinations are four tests which were 
made with blood from cases diagnosed clinically as typhoid; one 
taken the tenth day of the sickness, two on the twelfth, and one 
on the sixteenth day. One of the cases examined negatively on 
the twelfth day was positively diagnosed on the fourteeth. 
Api^arently there is no definite time for the appearance of the 
reaction in tyjDhoid and the fact that a certain number of days of 
sickness have passed without the reaction does not necessarily 
justify the conclusion that the disease is absent. 

I am of the opinion from the results of the examinations as 
conducted by the Department, and from the expressions of 
opinions of those practitioners who have availed themselves of 
it, that it is of considerable value in diagnosis. These facts 
warrant continuance of the typhoid diagnosis by the Department 
and for the present at least the use of dried blood specimens, 
principally because of the simplicity of the method. Public 
health authorities are not obligated to emj^loy the typhoid diag-- 
nosis, as they are the bacteriologic diagnosis of diphtheria and 
cholera, because the treatment of tyjihoid is not conducted by 
health departments, nor are these patients quarantined. Here 



Results of Widal's Test—Gehrman. 49 

m Chicago, however, typhoid has been such an important factor 
In the health of the city and has such an influence upon the death 
records, that every means for the study of the disease should be 
used and improved. If it can help diagnosis the death returns 
more accurately, and if it can assist in showing changes in mor- 
tality from time to time, a better basis is offered for observations 
as to the effect of sanitary measures introduced to control the 
disease. 

Finally, in view of the 3.3 per cent of failures in diagnosis 
that appear from the Department's examinations, those condi- 
tions should be considered which may assist in correcting the 
results. 

The directions for obtaining and transmitting specimens 
must be closely observed, especially as to the drying of the 
blood. 

Several examinations of each suspect should be made when 
the first test does not appear te be conclusive. 

In the laboratory further dilutions of the blood solution must 
be made and tested in those cases showing the reaction. In this 
way normal or pseudo reactions can be eliminated. 

By closely observing these details, it is highly probable that 
the test will be more exact and the failures fewer in number. 

REFERENCES. 

1 McParland— Pathog-enic-Bacteria, 1898. 

2 Biberstein — Beitrage zur Serodiagnostic, etc.; Zeitschrift fuer 

Hygiene, Band 27, Heft 3. 
.'5 Kuhnan — Berl. Klin. Wochenschr.. 1897, No. 19. 

4 .Johnson and McTaggart — Montreal 'Medical .Journal, March, 

1897. 

5 Block, Bates — .Journal of Am. Med. Assn., July 3, 1897. 

6 Stewai't — American Pub. Health Assn., October, 1897. 

7 Courmant — Le Semaine Medicale, 1897, p. 209. 

8 Stern and Sklower — Inaugural dissertation, Leipzig, 1897. 

9 Ziemke— Dtsch, Med. Wochenschr., 1897, No. 15. 



THE PLEXUS 

THK OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPAKTMEXT 
UNIVERSITY OF ILLINOIS. 

Editor, H. J. STEGEMANN, '02. Busitiess Mgr. G. G. DOWDALL, '00. 

Class Editors: 

F. C. BL\CKWELD(ER,'O0. W. O. McDOWELL, 01, J. M. MEYERS, 02 



Faculty Department, Dr. W. A. f usey. Athletics, 

Alumni, Dk. Louis J. Mitchell, 71 Lafliii Street. Clinical Dspartmeut, E. A. Gansel 

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should so notify the Publisliers; otlierwise it will be assumed ^hai the subscription is to be 
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Contributions of matter suitable for publication ar-e invited, and should be sent in not 
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EDITORIAL 

The high econiums paid the Plexus by tlie Faculty, the 
Instructors and the* Alumni of the P. & S. assures the managers 
that the increased expenditure in improving the appearance and 
usefulness of the Plexus was not in vain. Another marked 
deviation from the old custom will be the continuation of publi- 
cation during the months of July and August, heretofore the 
publication of the journal has been suspended during the afore- 
said months. We trust that the change will be acceptable and 
appreciated by the readers. 

* 
The Plexus will duly thank any of the Faculty, Instructors, 
or Alumni of the College of Physicians and Surgeons, or any 
others of its many subscribers who will write us the particulars 
of any interesting case coming under their observation. The 
Plexus is published for the good of the doctors and any thing 



Editorial. 51 

that will prove a benefit and of interest to them will be willingly 
presented in our columns. We feel assured, too, that what 
will interest the practitioner will also interest the embryonic 

doctors in our midst. 

* * 

In the May issue of the Plexus we stated that we would 
publish original articles by graduates of the College of Phy- 
sicians and Surgeons. 

Dr. Weller Van Hook of the class of '«o has favored us with 
the first article, an extremaly interesting and scientific one. Of 
the graduates of this school none rank higher in the medical 
profession, than does Dr. Van Hcok, and the record made by him 
has indeed been a brilliant one. 

In addition to a very good likeness of the doctor we are also 
able to give a short biographical sketch of him, as follows: 

Weller Van Hook, born 186i!, was educated at Louisville 
High School (1881); University of Michigan 1884 (A. B.); College 
of Physicians and Surgeons Chicago (M. D.) 1885; Cook Co. 
Hospital 1885-7; Post Graduate work in Berlin, Vienna, Paris, 
London, 1S94-5. From 1887 to 1894, general practice on West 
side. Since 1895, practice limited to Surgery. 

Has taught in College of Physicians and Surgeons and Post 
Graduate School. Now Professor of Surgery in Northwestern 
University Medical School and in Chicago Policlinic. Surgeon 
to Cook Co., German and Wesley Hospitals. 

It is with great pleasure and gratification that we note the 
annual yearly increase of students attending the P. & S. school. 

Each year, as is shown by the following table, shows a 
marked increase in attendance over the preceding year and the 
indications are that the splendid showing made in the past four 
years will be outdone in the next few years to come, inasmuch 
as, that as each graduating class is proportionately increased, it 
naturally increases, to the same extent, the number who go out 
into the world to i3ractice and who will recommend this school 
above all others to prospective students of medicine. Thus the 
school becomes more widely known each year and as a result of 
this the attendance will not fail to show decided gains. 

Not only has the school shown an increase in attendance 
but, owing to the high class of physicians and surgeons grad- 
uated each year, the standing of the school in the medical edu- 



0*^ 



THE PLEXUS. 



cational world has been raised to a degree second to none. 

The record made in the past few years is one that each 
alumnus has every reason to be proud of. 

The following table shows the percentage of gain in the past 
four years. 



The 

attendance 

ill 


was 


Beins an 

Increase 

of 


Percentage 

Increase ovei 

1S95-6. 




1895-6 


235 










1896-7 


3(18 


•-o 


or 31-1- 






1897-8 


4(19 


101 


or 74-1- 


or 32^7 


9 over 1896-7. 


1898-9 


5U6 


97 


or 115-i- 


or 23+ '7 


over 1897-8. 



To Dr. Wm. Allen Pusey, w^ho has been secretary since the 
year 1896-7, and the very efficient faculty is due the credit for 
the splendid record made, Long may they continue their good 
work. 

* 

The April number of the monthly bulletin of the Depart- 
ment of Health, City of Chicago, gives an interesting table upon 
the increasing duration of life in Chicago. 

In 1869, the average of years for every individual decedent, 
old and young, was 13.9 years; in the year 1872, the average had 
increased to 15 years, 2 months and 10 days; in 1882, ten years 
later, the average was 19 years, 7 months and 1 day; in 1892, 
after another period of ten yeare, it had reached 22 years and 8 
months, and in 1896, but six years later, the records show an 
average of 29 years, 4 months and 16 days. 

It will be noticed in the above that, as the years progress 
and medical science becomes more and more proficient, the 
average age of decedents gradually increases. 

During the period of ten years, from 1872 to 1882, it increased 
nearly four, years; from 1882 to 1892 the increase was not so 
marked, being only about three years increase; while during the 
period of but six years, from 1892 to 1898, is shown a most 
startling and gratifying increase in the average of life in the 
city, the increase being nearly seven years or nearly as much as 
in the twenty years preceding. 

Measured by the average age at death of all who died in the 
city of Chicago, 20 years ago, and of those who died last year, 
the records show that the average duration of life has more than 
doubled during a single generation. 

The bulletin further shows that in the decade 1845 to 1854 



Z;-,-^. , Editorial. \_\ .53 

the average annuiiLVleath rate..w.as,:4O.0 -per thousand as com- 
pared with an average annual deatli rate of but 14.4 per thou- 
sand in 1898, demonstrating- on this latter showing a saving of 
41,050 lives per annum out of the average population (1,611,^!^5) 
of the last five years. 

The most important feature is the showing of a marked 
reduction in the proportion of infant and child mortality to the 
total mortality of all ages. There is demonstrated a reduction 
of 30 per cent, in the proportion of under-one-year deaths; of 
nearly 56 per cent, in the proportion of between-one-and-two 
year deaths and of more than 45 per cent, in the proportion of 
between-two-and-five-year deaths, which altogether over- 
shadows, in sanitary importance, the increasing proportion of 
those who live to "middle" life and beyond. 

The increasing duration of life in Chicago is thus seen to be 
progressive and certainly augurs well for the coming gener- 
ation. The rapid strides now being made in the medical science 
will be a jDotent factor in further increasing the average age 
since it is being demonstrated daily that those diseases that have 
heretofore carried off such large numbers before their time are 
gradually being mastered and 'twill be but a short time when 
contagious diseases will be controlled, with but a minimum loss 
of life. 

* 

It" is almost impossible to conceive that such gross illiteracy 
is to be found in the ranks of the medical profession to-day, yet, 
the letters printed below are evidence that such is the case. 

The writer of these horrible examples of composition and 
spelling is no doubt well advanced in years and possibly has not 
had the educational advantages to be obtained at the present 
day, therefore he has a shadow of an excuse for his ignorance. 
To-day, however, there is no excuse for such woeful lack of the 
very rudiments of an education yet we are sorry to state, compo- 
sitions, almost as bad as these j^rinted here, are handed in, in the 
form of written examinations, to some of the instructors, by 
students attending the school at the present time. 

No doubt other schools have similar cases, which does not 
necessarily reflect on the examining board which passes on the 
applications for admission, since most students present diplomas 
or other evidences of having had alleged satisfactory pre- 
liminary education. 



5-t THE PLEXUS. 

It is after a student has g'raduated froiira school of medicine 
that he cases reflections on thb institution from which he is 
allowed to graduate and from which he receives the degree of 
M. D. if he is deficient in even the simplest accomplishment of a 
scholar. 

The following are exact copies of the composition, spelling, 
punctuation, etc., referred to above except that the name of the 
writer is represented by blank lines. 

Office, Home and Farm of Dr. 

(1) Spring Hill, Ark. 3.d-28 Da, 1899. 

Dr. W. C. Cardwell, sec"y. Ark. St. m. Soty. 
Dear Sir and Friend 

Your letter Dat. 3-1-99 address to J. H. Spring Hill 

Ark. Whoom, Was my Father, the Same is Desest But the 

Request, and contents Was Probly entinded for me, if so, many 
thanks, if not, non the Less, thank, to the Society, in conclusion 
Will say, i am the only medical man of the above name is Spring 
Hill Ark. and have Desired to meet With the Ark. St medical 
Society, for reasons not stated, thare Being many things that 
come under my care, and observation, that Wood Bee Wirthy of 
Some considderation to the Sosity and also to me. Dear Sir if 
am counted Wirthy, Let me heare. Evr your. 



(2) Spring Hill, Ark. 

Office, Home and Farm of Dr. 

Med. Staif St. Luke Hospital nils Mich. 

Spring Hill, Ark. Mch. 31st, 1899. 
My Dear Sir & friend. Carrillon, Ark 

Dr. Wm. C. Cardwell. — I am in receip of your Letter of mch. 
31st in Which you Solisite me To meet With the ark Sta medi 
Soscity vis May 10. 11. 12, 99, at Little Rock, ark. Dir s. I 
assure you and Socity of my most Hearty appreciation, of your 
Solisitation to me. Rilative to Writing a Paper on Surgery or 
To Report Some Peculiar Cases, Coming under my Persnal. 
Knollidg that Wood Bee of Some interest to the Proif, and State 
at Large, Will State Wright Heare, Whereas in olden times it 
Was an ancint. and Laudable custom, and one commended By all 
men, that those persons Who Devoted their Studys of the nobil 
arts and Sciences and practicing men Should Receive Recog- 
nition and Reward and Be elevated to a high Rank and Degree 
By thir Fellomen, and thw art mindfull to conddsend to men of 



Editorial. 55 

Lo estat thearefor Being not unmindful of your exelent methods 
of Revelation, to each other. Tho I am the Le.st Worthy, of 
membership in your Honrabel Ranks, and as I am not a grage-^ 
uate in all the Soceil — Branches of your Horn. Ranks, Wood 
Like to — Lean upon — an Weak, and hov nead of all aBove for 
thare is non Higher thin the Hiest of all, and our Wisdom come 
in that Way Whitch wee Seak it, and so in all cur Profs — 
Remidis & prects So I am Proud To congratulate ya all in The 
Hiest a. Littel one. Like me. I have some exsperance in Sur- 
gey, Was chosen By exepert Surgons, to Work in the Surgons 
Department — 61 — 65. Latter Part, u. s. s. Red River Hospital, 
and frome 65 to Present Date have Benn engaged in the Profs. 
Study, and meds to meat the ills of Human famity, & ea. als as a 
visieting and consulting member. Whin cold upon of the St Luke 
Hospital nils, Mich. 

And Have Deplomer of member Ship, Theare too Will Say 
for Publication, or your considerations I have a. case, that Wood 

come, under the Head of 1st. case, Phennominel Seems to 

Be Contrary to — the Law of nature; a Ladia 75 years of age 
Became Pregenent, after turne, of Lief, had exspierd, 10 year, 7 
years Since the Last menstrel Signes Was noticebel. By Pacts 
the cause, and my knolleg. of the case, of Delivery and the 
length of time taken to deliver and Why, and How, and the 
Results & ec. 

2 Case. Mettel Catheter 

Case 2. — a metel — Oatherer, I found in the Blader. of a, 
young man. Who Was Sent to me for examination, & Cear, the 
cause of same, and the condition of Patent, and Length of Time, 
the Same Was in the Bladder, Ways and means of extracting 
Same Results, & ec. — many Other Like cases I omit for fear of 
taxing you. 

Know my Dear Doctor you can submit my letter, in ancer to 
yours to the Proper, conceils, and if in your judgments I Wood 
Bee Wirthy To member Ship in your Society By Taking What I 
have Written and the 2 cases I Pirpos, to Report, for critisism, 
or endorsement, ceartly considdering, my Long experance, and 
Lemited a billetty and Labatry. and Remember By Practi. men 
Become Perfect, in every Branch of Survice, and Remember, 
thare is given talants and Wee are commanded to improve thim, 
and, consider, morover the Otharol and commandment given by 
Lord of us all. now— in conclusion, Will Say if my fiancil cir- 
comstans Per mite. Will Be With you, Providid you Will Copy 
this Letter in Print, and Send me a Copy of the Same With 
Your Approval and Concel. Ever your 



EPIDERMIZATION SURGICALLY CONSIDERED. 
Weller Van Hook, A. B., M. D. 

It is unusual for a wound to heal so accurately that a small 
surface does not have to heal by granulation and epidermization, 
and many wounds by failure of coaption must heal throughout by 
this method. Hence the processes of epidermization and granu- 
lation are of prime interest in minor surgery. Even after major 
operations the patient is frequently incax^acitated for business as 
long by a small ulcer in the line of the incision as by the reaction 
of the operation. 

By epidermization we mean the clothing of a denuded part 
with skin. The process takes place in all cases from j^re-existing 
skin at the edges of the ulcer, from islands of skin not destroyed 
by the agency producing the trauma or from artificially implanted 
•epidermal cells. 

The histology of the process involves a number of curious 
changes in the epithelium which have been best described by 
Leo Loeb for wounds exiDerimentally inflicted upon guinea pigs. 
The whole epithelial mass at the borders of the wound soon be- 
comes softened and begins to move toward the center of the 
wound. The distinctions usually observed between the cells are 
lost and we have a homogeneous collection of protoplasm con- 
taining enlarged nuclei pointing in the direction of the migration. 
The epithelium undergoes reproduction of nuclei by mitosis and 
by amitosis. This remarkable migrating mass penetrates ob- 
structing bodies, such as blood clot, occasionally connective tis- 
sue, and, says Loeb, "It was even possible to get microscopical 
specimens in which all stages, of the epithelial tissue breaking 
through the cartilage of the ear and dissolving it could be seen." 
Not only do epithelial cells penetrate and pass through foreign 
masses, or masses which are partly foreign, but they sometimes 
divide into two parts, pass around them as if they were obstacles 
in their path and meet on the opposite side of the obstruction. 
From what has been said, it can be seen that the regenerating 
liower of the epithelial tissues is enormously great, and that this 
regenerating power is able to act even against considerable re- 
sistance. But it must not be supposed that these resistances are 



Epidermizat ion Surg kally Considered — Van Hook. 57 

to be thrown in the wdy of advancing epithelial cells without due 
consideration; in fact, we shall see in a few moments how impor- 
tant it is to remove obstacles in the w^ay of advancing epithelial 
cells. 

The favoring moments acting upon proliferating and spread- 
ing epithelial cells are, first, a healthy condition of the epithelium 

















Deutsche Zeitschrift, f. Chirurqie Bd. XLVIII. Tafel I. After Enderle. 

Fig. 1: Illustrating the transplantation of skin several 
days after its removal from the donor. 

The piece of skin which was still moist after four days, was 
grafted on a thorax defect where it was allowed to remain for 
four days when it was removed with some of the subcutaneous 
tissues. 

The epidermis is to be seen elevated in the form of a blister. 

From the basal epithelium cell-proliferation has proceeded 
At one point the cells have penetrated completely the cutis of 
the graft. 

The cutis is pale with only a few degenerated old nuclei 

visible. 

(b) Blister-like elevation of epithelium. 

(c) Pale transplaated eutis with scattered remnants of nuclei. 

(e) Epithelial prolongation which has proliferated ttirough the cutis to 
the connective tissues. 

(f) New connective tissues which here and there show a tendency to 
g row upward through the tfansplant^d cutis. 



58 THE PLEXUS. 

itself; second, a normal condition of the field over which the 
epidermal cells are to grow, and, third, a certain limitation in 
the area of the field which is to be covered by the new cells. 
Retarding- conditions are all of those mechanical obstacles which 
stand in the way of progress of the epidermal mass, an unhealthy 
condition of either the epidermal cells or the granulation tissue 
over which they are to grow, and finally an excess in the size of 
the field which is to be covered. It seems with reference to this 
last point, that it is impossible for the epithelial cells to continue 
to regenerate for more than a certain time, as if the vitality of 
the cells were after a time worn out by reproduction. Besides 
this, when areas for epidermization are too extensive, the blood 
supply of the connective tissue begins to fail on account of the 
contraction in the deeper connective tissue layers. The practi- 
cal hints to be taken from this brief consideration of the histology 
and physiology of epidermization are very numerous. 

We may pass by as comparatively well known the old precept 
to cauterize exuberant granulations near the advancing line of 
ejDidermal cells. It seems to me that the application of silver 
nitrate to granulations in the neighborhood of advancing epider- 
mal cells has the eifect of stimulating the epidermis itself and 
making it grow more rapidly. One should be careful to note in 
all clinical instances the exact line of demarkation between the 
epithelium and the connective tissue. It can be recognized as a 
bluish white layer, having a somewhat glazed or dry appearance 
in contrast with the moist apj^earance of the granulations over 
which the line is spreading. If this delicate layer of epidermal 
cells is destroyed by the silver nitrate, the processes of epider- 
mization will be correspondingly retarded. It is very important 
that epidermization should not be required to take place in this 
manner over too large an area, for the first reason because of the 
excessive production of dense scar masses which constitute a per- 
petual menace and source of discomfort to the patient; and, in the 
second place, because the epidermal reproduction itself is very 
imperfect when this method alone is utilized. 

It seems to the writer that the Thiersch method of epidernni- 
zation is too little utilized, even in comparatively minor cases. If 
the technique were more generally understood and had been put 
in application by a larger number of practitioners of minor sur- 
gery, there would be fewer broad scars covered with thin and 
unhealthy layers of imperfect skin. The technique of transplan- 



Epidermizaticn Suryically ConsiiJered — I'an HooJc. 59 

tation of skin by Thiersch's method is briefly to shave from the 
surface of a convenient portion of the skin of the patient, say the 
inside of the thighs or of the arms, thin layers of the epidermal 
cells, leaving the cutis intact. This layer of thin epidermal cells' 
is then applied to the properly prepared granulating surface. 
The most important point in the detail, it seems to the writer, is 
that there shall be no fluids used in the preparation of the grafts 
or in their application upon the granulating surface except the 
blood and lymph of the parts. The hands of the operator should 
be dried with alcohol and a sterilized dry towel. The skin should 
be dried with alcohol and ether, and then with a dry razor the 
epidermis should be removed. The epidermis will not spread out 
into a thin flat layer, as is the case when salt solution is used to 
flood the razor, but will roll up into a mass looking somewhat 
like a Venetian window-blind. This mass, it would at first ap- 
pear, would be awkward to handle, but by placing the needle at 
the very edge of the flap, after it has been cut off, and holding the 
edge of the fla]o down upon the surface which is to be covered, 
then drawing the razor slowly and gently away from the needle, 
the flajD can be spread out almost, if not quite, as evenly as if 
water were used. Of course the granulating surface is to be 
properly prepared by curetting or by shaving oft" the surface of 
the granulations. After this has been done a compress is laid 
upon the bleeding surfaces and pressure kept up unintermittingly 
for from three to ten minutes until all bleeding has entirely 
ceased. In this way no clots of blood will come to lie between 
the epidermal mass and the granulating surface to interfere with 
the direct nutrition of the epidermis. The advantage of doing 
away with fluids of all kinds, antiseptic and aseptic, physiologi- 
cal salt solution, etc., is that absolutely nothing is used to dilute 
the blood plasma and lymph which are to nourish the epidermal 
cells from the beginning, and, much more important still, are to 
fasten down the epidermal layer into its proper position by the 
accumulation of fibrin. 

Graser's beautiful experiments have shown that fibrin will be 
formed from granulation cells themselves, as well as from the 
broken down blood corpuscles and other blood elements within a 
few hours after proper irritation has been eftected and there can 
be no doubt that epidermal layers applied in the manner de- 
scribed will adhere as tightly as peritoneal surfaces will unite 
under the same conditions. This idea of using no fluids in the 



60 



THE PLEXUS. 



application of the grafts the w^'iter has borrowed from Krause, 
who recommends the method in the application of his "unped- 
ic led flaps. ■■ By the term unpedicled he means flaps containing 
not only the epidermis, but also the derma, so that it is necessary 
to have exceptional conditions in order to obtain a good clinical 
■result. Krause has succeeded by using this method in covering 
large surfaces with thick layers of skin, with the result that 
the scars have been very much diminished in density and the 
quality of the new skin is much better than that of Thiersch. 
Thiersch's method suffices, how^ever for all ordinary purposes, 
especially for the smaller denuded spots, the thin epidermal layer, 
after a short time, proliferating until the new" skin has resisting 
powers that are not at all possessed by skin which results from 
the epidermization by. natural j^rocesses from the periphery. 

In recent times two writers, one in Germany and one 
in America, have recommended a process which is extremely 
ingenious and even startling from a biological point of view. 
They have suggested the removal of epidermis by means of 
blisters, the drying of the epidermis and the reapplication of 




Arcliiv f. Mlkr^skopische Anatcmie. Bd. XXXVII, Af. 3. After Barfurlh. 

Fig. 2. Caudal end of the frontal section of the tail-end 

of siredon pisciformis lar\"a, 4 cm. long. After amputation of 

the tip of th3 tail regeneration had been allowed to progress for 

for one and one-half hours at a temperature of 18*^ c. 

(p) Pi<,'-ment cells, 
(f) Fibres cf connective tissue. 

fe) I']pitheliiim spreadino- over the wound consisting- of pre-exlstsnt 
epithelium which has mig-i-ated. 
fc) Liniir, of the cutis. 



Epidemrization Surgical/ ij Gonshlered — Van Hook. (il 

"this material to raw surfaces after days, weeks or months. Dr. 
Lusk, of New York, and Wentscher, of Germany, have each 
of them reported numbers of cases in which this method has suc- 
ceeded. Dr. Lusk's report is more enthusiastic than that of his 
German colleague. The latter reports fifty-nine cases in which 
the grafts were preserved either moist or dry for some three days 
to a number of months, with eighteen clinical successes. 

Enderle, who has recently reviewed this topic experiment- 
ally and clinically, maintains, however, that good results cannot 
be clinically expected if the grafts have been kept more than 
four days. This limit, however, gives us an enormous advantage 
in obtaining masses of epithelial cells from amputation stumps, 
from cadavers, or from the skin of patients undergoing opera- 
tions, so that the material can be easily removed and kept until 
wanted. 

The writer had an opportunity to show at the clinic of the 
Cook County Hospital a year and a half ago a child upon whose 
arm he had j^lanted at least twelve square inches of epidermal 
tissue, i-emoved from a cadaver twenty-four hours before their 
application. Healing was perfect throughout. 

In conclusion, we may say that even this method is not nec- 
essary in order to afford a convenient-means of covering denuded 
surfaces with epithelium, for it is quite possible to remove epi- 
dermal tissue in sufficient quantity for all ordinary work by the 
use of the infiltration method of Schleich. The inside of the arm 
or thigh, after being properly cleaned and dried, is infiltrated 
throughout the desired area with the weaker infiltration solution 
and the razor or amputating knife is then used in the ordinary 
way to raise the required graft of skin. 



A CORRECTION. 

An apology is due Dr. F. S. Diller, of Roberts, 111 , whose 
communication, which appeared in the last issue of the Plexus, 
among the Alumni Notes, was misquoted. He is quoted as 
having said: "Saw patient first on 8th day of April, (after birth 
of fhild). Saw her again on April 24th, when she stated, etc. :" 
Whereas, it should have read: "saw patient first on April 24th, 
eighth day after birth of child, when she stated,"" etc. 



METHOD OF USING PROTARGOL IN GONORRHOEA. 
J. Stephan Nagel, Ph. G., M. D, 

Assistant Geuito-Urinary Surg-eon. Chicago Clinical School, /Attending Phy- 
sician to West Side Free Dispensai-y. 

This comparatively new anti- gonorrhoicum is a stable proteid 
compound of silver, more soluble than argonin, and possessing 
peculiar diffusing properties and is less irritating than silver 
nitrate, I especially invite the attention, to the use of this drug, 
of those who still follow the old method of combating this disease 
with balsam copaiba, oil of santalwood and astringent injections. 

In over fifty cases, I have never seen its use attended by any 
unpleasant results. 

The general plan of treatment which I shall outline must 
necessarily, be varied some to suit individual cases. 

The protargol injections should be commenced as soon as 
the discharge appears and continued as long as the microscope 
shows any of the gonococci present. The treatment should be 
started with a one-fourth of one per cent, solution in distilled 
water, to be used in a blunt pointed hard rubber or glass syringe. 
The patient is instructed to inject one syringeful every four 
hours dan and night and to retain it in the urethral caual, by 
compressing the meatus, for two or three minutes. In order to 
bring the disease to a termination in the shortest possible time, 
it is quite essential that the former condition be insisted upon 
and explained to the patient the necessity of combating the 
infection the entire twenty-four hours. Where this is not done 
the germs are allowed to go on multiplying, unmolested, from 
eight to ten hours. At the end of live or six days the strength 
of the solution should be increased to one half of one per oent. 
The amount of discharge and the number of gonococci will have 
materially decreased and the mucous membrane of the urethra 
will have become more tolerant. The interval between injec- 
tions should now be lengthened to six hours and the solution 
retained for four or five minutes. This should be continued for 
another five or six days, noting all the time that the amount of 
di.schargo is on the decline, and, if the microscope be brought 
into use, we will see a further diminution in the number of 
gonococci. 



Protdrgoi in Goaorrhoea. — Xnfjil. 63 

T>ie amoiuit of protai'o'ol should again be increased to three- 
fourths of one per cent. The interval lengthened to every eight 
hours and length of time of retention, six to eight minutes. If 
at the end of the third week the microscope shows a few lurking 
gonococci, the strength of the injection should be increased to 
one and one half per cent, and injected twice daily; to be retained 
in the morning for ten minutes and in the evenings for fifteen. 
If the patient finds it impossible to retain it for this length of 
time let him use two or more injections, exprassing the previous 
one, and noting time of retention of each. 

In following up this method of treatment an uncomplicated 
case of anterior urethritis can, in the majority of cases, be en- 
tirely and permanently cured in from fifteen to eighteen days. 
The following table will give at a glance the general plan to be 
observed : 

Strength of injection. Length of retention. Interval between 

injection. 
i% " 2 to 3 minutes 4 hours. 

+ % •' 4 to 5 " "6 " 

I to 1 % " 6 to 8 " H " 

li% " 10 to 15 " 12 " 

The microscoj^e is an essential factor in the treatment of this 
disease, for, as previously stated, the protargol injections should 
be continued until all the gonococci have disappeared, then and 
not until then should its use be dispensed with. Again, fre- 
quently after all the gonococci have been destroyed, we have a 
catarrhal discharge remaining composed of leucocytes, epithetial 
cells and mucous. 

This is the period when astringent injections, such as, 
copper and zinc sulphate, lead acetate, hydrastine and many 
others, play an admirable part in the course of gonorrhoea. 
They may be used in conjunction with protargol in the later 
stages where we have an abundant catarrhal discharge, and only 
a few gonococci, using them twice daily and one and a half per 
cent, solution protargol once daily. 

No internal medication need be given unless the urine is ex- 
cessively acid and causes undue burning on urination, when any 
of the alkaline diuretics can be administered. Should painful 
erections give the patient any inconvenience the following- 
powder may be given at bedtime: 

B Patossii Bromuli 

Aiitipvriu an grs XV 
M ft. chart. No. I 



64 THE FLEX U.S. 

To close with I wish to quote from Neisser as to this remedy: 
"Protargol is the best, the safest, the most rapid, in fact, the 
ideal remedy for gonorrhoea, inasmuch as the gonococci are 
killed without the mucous membrane being affected or the in- 
flammation and suppuration increased.'" 

323 So. Western Avenue. 



A RAPID METHOD OF PARAFFIN IMBEDDING. 

By S. H. Champlin, M. D. 

This subject has been treated of in numerous magazine 
articles, appearing from time to time in different journals, and 
hj different writers. These methods, as described by various 
authors, take from thirteen to twenty hours in their con- 
summation. 

The method, to be described, is actually rapid, and has the 
added virtue of being extremely useful for diagnostic purposes; 
and the specimens, so obtained, are permanent. 

The method, in detail, is a follows: a piece of fresh tissue, 
the thickness of a thin or medium microscopical glass slide, is 
suspended in absolute alcohol, from two, to two and three- 
fourths hours; it is then placed in benzol-cedar-wood oil mixture 
until semi-transparent, and no whitish areas appearing in any 
part of it (usually from ten to thirty minutes), the tissue is now 
put into melted paraffin, heated to not less than 47 degrees C. or 
more than 50 degrees C. This paraffin is a mixture of one part 
hard paraffin (50 degrees C. melting point) and two parts soft 
paraffin (40 degrees C. melting point). The bath, in paraffin, 
should be i^rolonged until the tissue is opaque, as it was at the 
end of the alcohol bath, — if it is at all translucent it must be 
returned to the i)araffin bath until opaque. The specimen, at 
this point, should be carefully watched, as some tissues will 
begin to shrink as soon as infiltration is complete, and should be 
removed and imbedded at once. Other tissues, that do not show 
this tendency to shrinkage, may be left in the paraffin bath 
indefinitely, without detriment. 

This bath should require from five to thirty minutes. 

The specimen is now imbedded in melted paraffin, of a 
mixture of two parts of hard and one part soft, and allow^ed to 
cool slowly until semi-solid, when it should be rapidly cooled in 
ice water. 



Para (fill Imlieddiiig — Champlin. 65 

Sections are cut; affixed to slide with Mayer's albumen 
mixture; passed through benzine and 90 per cent, alcohol; stained 
first with dilute aqueous solution of China blue or Bleu de Lyon, 
rinsed in water, and then brought into safranin solution, for a 
few seconds; washed with absolute alcohol, until the blue 
becomes prominent; cleared with clove oil and mounted in 
Canada balsam. The safranin solution is made by adding one 
part 40 per cent, formalin to four parts of saturated aqueous 
solution of safranin. 

If a more selective stain is desired, for the demonstration of 
karyokineti3 nuclei the section should first be stained with 
safranin; washed lightly in 70 per cent, alcohol, containing 5 per 
cent, picric acid, and finally in absolute alcohol. The tissue, so 
treated, may be of any length or width, but must not be thicker 
than mentioned above. The fixation and hardening is accom- 
plished by the use of a four-ounce bottle, the bottom of which is 
covered to about an inch in depth with burnt co2:)per sulphate 
and then filled to the shoulder with absolute alcohol; this amount 
can be used for twelve or fifteen specimens, or used until the Cu 
SO4 becomes blue, when it must be changed. One end of a 
thread is attached to the stopper and the outer end supports a 
bent pin, the thread being of such length as to permit of the pin 
resting just below the surface of the alcohol. The tissue is hung 
on this pin, and the whole dropped into the alcohol — the bottle 
being tightly corked. 

By i3reference the benzol -cedar- wood oil mixture should 
consist of one and one-half parts of thick cedar-wood oil and two 
and one-half parts of pure benzol. 

If thin cedar oil is used the mixture then should consist of 
equal parts. The thin oil does not give as good results, 
however. 

I have used this method for four years, and in my hands it 
has been much more satisfactory than the freezing methods. 
The entire process can be carried through in from three and one- 
half to four hours. 

Chicaeo. 



•Alunppi Deparbmepb. 

Dk. Lewis J. Mitchell. Editor. 

At the recent meeting of the Alumni Association it was easy 
to be seen that that body was anxious for a more active existence. 
The latent energies were apparent. It behooves the officers to 
find opportunity for the exhibition of those forces. 

The graduates of the institution will be card indexed at once. 
Each card will give the name of the graduates, his address, the 
j^ear of his graduation and such biographical data as will inter- 
est those interested in him. After this has been filled out, all 
changes or other items relating to him that appear in the 
Plexus or in other sources of information Avill be added to data 
already on the card. 

We will straightway make an active canvas of the graduates 
with a view first to making every one a member of the associa- 
tion and second, seeing that every one reads the Plexus. 

What will be done next is not fully determined. 

In the meanwhile this much is sure. 

The next annual njeeting will be made very entertaining and 
perhaps instructive. Put it on your list for next year and then 
cut the ballance of the pattern to fit it. 

W. A. Evans Sec'y. 

'83. Dr. Z. T. Harvey writes from Council Grove, Kans., to 
say that he has been living there for fifteen years and is surgeon 
for the M. K. & T. and the Missouri Pacific. 

'85. Dr. Weller Van Hook was elected Vice Prq^iident of the 
Illinois State Medical Society at its last meeting. 

'85. Dr. A. W. Dunning of St. Paul, is one of the editors of 
the department of nervous diseases and medical jurisprudence 
in the St. Paul Medical Jourmal. 

'89. J. H. Radley, who was president of this class, made a 
flying visit to his Alma Mater recently and incidently informed 
us that the practice of medicine in New York City, from his 
stand point, has been very gratifying. 

Dr. Radley certainly bears the marks of a successful practi- 
tioner and the geniality with which he deposited his advance 



Personal. 67 

supscription for the Plexus left a very good impression of the 
east. 

'94. Dr. A. M. Harvey has removed his ottice to suite 300; the 
A. J. Stone Building', Chicago. 

'99. Dr. C. E. Sisson under date of June 12th 1S99 writes. 
"Today I received my appointment as physician at the State 
Hospital for insane, and my address will be Mendota, Wise. 
Put it in the official organ S3 all of the boys will know where I 
am. It is an elegant place, just across the lake from Madison 
and we won't do a thing." 

He also sends best wishes to all of the boys. 



PERSONAL. 

Dr. Wm, Allen Pusey, Secretary of the College of Phy- 
sicians and Surgeons, was recently elected president of the 
directory of the Physicians Club of Chicago. 

Dr. J. H. Curtis, Professor of Therapeutics of this school, 
having decided that, "'tis not good for man to be alone" took up- 
on himself the cares, trials and tribulations of a benedict. The 
Plexus heartily congratulates him and wishes him a long and 
happy v/edded life. 

Dr. D. A. K. Steele left Chicago for Europe on June 12th 
last, to be gone three months. The doctor will visit the various 
renowned medical centers of the old world, and has promised 
the readers of the Plexus an interesting letter, comparing the 
surgery of the old and new worlds. This letter will appear in 
the August issue. 

Dr. H. P. Newman will soon leave for a trip across the pond 
to visit his family who have been in Europe for the past year. 

Dr. W. L. Ballenger leaves this month to attend the Inter- 
national Congress of Otology which meets in London, England, 
on August 8th next, when he w\\\ discuss the indications for 
operations in chronic suppurative otitis media. 



SENIOR NOTES. 

If the law in chemistry is true, that matter can neither be 
auniliilated nor created, how can you make something out of '00? 

McHug-h objects to being called professor on the grounds 
that anyone possessing two cents worth of common gall, half an 
ounce of laudanum and a ten cent jack knife with the determina- 
tion of using them calls himself professor. 

Gansel has demonstrated his ability as quiz master to the 
complete satisfaction of Dr. Cheney and the entire class. 

Arrangements are being completed for replacing some of the 
seats in the clinical amphitheater with a couch. Masilko seems 
to have some difficulty in taking his customary, while sitting in 
a hard seat. 

It may be of interest for some of us to learn that right in 
our midst there is an authority (just think of it!) on diseases of 
the heart. Concerning the prognosis of hypertrophy and dila- 
tion of the heart, " Why" Wall assures us that if compensation 
is good the heart may last a life time. This reminds us of the 
lad who said about fighting a fellow twice his size, that he would 
rather be a coward for fifteen minutes than a corpse for the 
remainder of his life. 

Ask "Tod Sloane"" Miller how he happened to be mistaken 
for the milkman. 

Monahan has matriculated. 

Johnston has had his hair cut. 

Have you heard about the great obstetrical curiosity? 
For details inquire at the Plexus office. 

Hart is raising whiskers! Cheer up, old man, you may still 
become a man before your mother! 

For the spring term at tlie P & S, "Mark"' Hannon has sub- 
stituted a matrimonial course. Rumor has it that "Mark" is 
now a married man. 



THE CLINICAL LABORATORY. 

By Sadie E. Greenfield. 

Through the earnest endeavors of Dr. Coates, we are able to 
announce the establishment of "The Clinical Laboratory" as a 
department of the college work and that a course in advanced 
laboratory, and original research work, will be offered to third 
and fourth year students during the coming school year. Any- 
one wishing to follow out any line of work in pathology, bacter- 
iology, clinical diagnosis or experimental physiology, will have 
ample opportunity for doing so. 

The course is to be optional, but it is hoped that many will 
avail themselves of this excellent opportunity; we cannot have 
too mh scientific training. On this foundation rests ou r future 
success. The rapid progress wiiich has been made in medicine 
during the last decade, is nearly all due to work done in the 
laboratory. 

We have been promised a number of improvements — new 
fables and lockers are to be put in, a set of blood instruments, 
an incubator, a new steam sterilizer, a new microtome, hydrogen 
generator for the cultivation of anaerobic bacteria, etc. Dr Coates 
hopes to be able to accommodate about twenty students. Each 
one will be supplied with the necessary articles for carrying on 
the work; no fee will be charged. 

The work in clinical diagnosis will be especially interesting 
and profitable. All work for the medical and surgical clinics 
held in the college amphitheatre will be done in this department, 
besides the examination of sputum, urine and blood for the various 
rooms of the dispensary. The professors have long felt the 
need of such a work, and it requires only the co-operation of the 
third and fourth year students to make it a brilliant success. 

Special efforts will be made to encourage research work by 
advance and graduate students in all lines of laboratory medi- 
cine. Reports of such work will be published from time to time 
in the Plexus. 

A laboratory reference library will be one of the features of 
the work. Such a library should include all the late works on 
laboratory methods, and technique, including files of the current 



70 THE I'LEXi'S. 

magazines devoted to experimental and research work. Mem- 
bers of the faculty and others interested in the advancement of 
laboratory medicine are urged to donate laboratory manuals for 
the clinical laboratory library. Back files and subscriptions of 
the current journals, such as: The Journal of Pathlogy and 
Bacteriology, the Journal of Experimental Medicine, Journal of 
Api3lied Microscopy, etc., are especially solicited. 

All works or journals so donated will form a part of the 
clinical library, to which students will have constant access. 

Laboratory work takes considerable time. This will probably 
be the greatest drawback. Nearly all the hours during the last 
two years are occupied so that students are in a measure justified 
in not wishing to attempt extra work. Bat as each one is to 
work independently, there need be no set time, whenever one 
his a free hour, it can be utilized. We hope, however that some 
time will be allowed for this work in next years schedule. 

A number of our students are working here this summer. 
Four members of the junior class are doing work in bacteriology. 
Five of the seniors are examining sputum, surgical specimens 
and anything else that comes in this line of work. 

One member of the Quiz class is making a spe cial study of 
general pathology. 

Dr. Yeakel is working in pathology etc.. and Dr. Coates, the 
director of the laboratory is doing research work on the parisitic 
origin of tumors, the result of which will be published later. 

The Clinical Laboratory has had an unofficial existance of 
about two years. The work already accomplished has borne 
fruit, as is shown by the fact that Dr. Yeakle, P. & S. '99, has 
been called to Omaha as professor of pathology, bacteriology and 
histology in the Omaha medical college. For the past two years 
Dr. Yealde has been persuing advanced studies in histology and 
pathology in the Clinical Laboratory, and will continue his \f ork 
during the present summer, leaving for his new field of labor 
next fall. His appointment comes as a fitting reward to time 
well spent in the field of laboratory medicine. 



QlipiGol IDepartrpeph. 

COLLEGE OP PHYSICIANS AND SURGEONS. 

E. A. Gansel. 

Prof. King's clinics conducted during the spring term will un- 
doubtedly act as a stimulus to good works in nervous diseases 
during the winter term. These clinics are held regularly every 
Friday and a large variety of mental diseases has been pre- 
sented for study. 

One of the most interesting cases shown in these clinics w^as a 
well marked case of paralysis agitans or Parkinson's disease in 
a man aged but thirty-one years. This man's symtoms began to 
manifest themselves when he was but twenty-eight years of age 
and all of the typical symtoms of this disease are now present. 
The case is a peculiar one because as a rule, the symtoms of this 
disease do not come on in an individual under forty years of age 

Prof. Gamble's clinical course on diseases of the eye is popular 
with all the members of his class. This is due very largely to the 
fact that the work is presented in such a way as to be of value 
not only to specialists in ophthalmology but to every student 
who. intends to begin the practice of medicine as a general prac^ 
titioner. 

Besides conducting the clinics at College, Prof. Gamble has 
sectioned the class and given them the opportunity of attend- 
ing the three clinics which he conducts every week at the Illinois 
Charitable Eye and Ear Infirmary. Thus every student gets 
an opportunity to thoroughly see and study the different condi- 
tions at close range. 

A case which has been of particular interest to the class was 
referred to this clinic by a physician who was a member of the 
P. & S. Class of '97. 

The case was first presented at the clinic on May 12th and was 
one of severe syphilitic iritis in a man thirty-five years of age. 
This man had a chancre about the first of April; on the first of 
May his vision began to fail and when he presented himself at 
the clinic on date above mentioned he could see but very little. 
Local application of atropine plus antisyhilitic treatment, espec- 



72 THE PLEXUS. 

ially Hg".. pushed to the pomtof tolerance gradually restored vis- 
ion so that on June 9th the vision was again almost normal, and 
the only indication still remaining was an irregularity of the 
right pupil. 

Peculiarities in above case were the early onset of iritis follow- 
ing' primary leasion and the fact that the eye at no time was 
painful. 

Prof. Steele has just inaugurated a plan which will certainly 
o-ive the students an additional interest in his surgical clinics. 
Up to the present it has been the custom for different members 
of the senior class to give an oral history of a case and if possible 
a diagnosis and there the work of the student ended. This 
method of course made the students do a part of the work of the 
clinic but the new system which Prof. Steele has introduced will 
undoubtedly make his clinical course one of the most practical as 
well as interesting studies for the senior year. 

As soon as patients present themselves for this clinic the se- 
nior students will be called upon in alphabetical order to ta''e 
charge of the different cases. When a case has been assigned to 
a student it from then on becomes his case, and he will be held 
responsible for the history of it from the first examination until 
the patient is cured or discharged from the clinic. 

Skeleton history sheets have been printed and when filled out 
by the student will give a complete outline of the case. When 
this is completed the patient and student appear before the class 
and the latter reads the history that he has obtained and then 
states his opinion on the diagnosis of the case. 

After the case has been treated or operated upon the student 
must still follow it up and from time to time give the class an ac- 
count of the course of the case. 

A copy of every history will be placed in a record book kept 
by Dr. Eisendrath for that purpose thus the course or treatment 
of any case coming to this clinic can be referred to at any time. 

The above plan is spoken of very favorably by the students 
now attending these clinics and it will without doubt be warmly 
endorsed by all of the students when they return for the work of 
the coming winter term. 

Prof. Murphy has done a large number of operations in his 
clinics during the past month. Among the cases of special in- 
terest which he presented was a very severe case of compound 



• Library Notes — Bryant. 73 

fracture of the bones of the ankle joints and a case of lupus of 
the neck with skingrafting. 

Prof. Ballenger performed an Asch operation for correction of 
a deviated septum. The patient was a young man whose nose 
was fractured by a blow from a hammer seven years ago. The 
segments of. the fracture had united in such a way as to leave 
only a small amount of external deformity but the internal de- 
formity was so severe as to interfere seriously with the patients 
vocal resonance, The patient is a professional singer and there- 
fore readily consented to undergo this radical operation to have 
his nasal respiration and normal resonance restored. 

The case was a very interesting one for the reason that it re- 
quired one of the most severe of nasal operations and at the same 
time one which students seldom have an opportunity to see at a 
clinic. 

LIBRARY NOTES. 
Grace W. Bryant, Librarian. 
The work of completing our files of journals has been 
progressing famously during the last month. Dr. A. J. Beh- 
rendt sent us an especially valuable box of journals, nearly every 
one filling a vacant place. An extensive exchange has been 
made with the R. I. Medical Society whereby many more volumes 
have been completed and several new books added. 

Cannot some of our surgeons help us to complete our annals 
of surgery? The volumes lacking are 1, 2, 17, 18, 23, 

The following articles from members of the faculty have 
been noted in the journals daring the last month: 

Dr. W. L. Ballenger, "A Laryngological Clinic." Med. 
Standard, June, 1899, p. 218. 

Dr. J. N. Bartholomew, "Traumatic Dislocations of the 
Femur." Chic. Clinic, May, 1898, p. 176. 

Dr. D. N. Eisendrath. "Treatment of Infected Wounds," 
Medicine, June, 1899, p. 441. 

Dr. Bayard Holmes: "The Medical College Library." Medi- 
cal Libraries, May, June, 1899, p. 30. 

Dr. D. A. K. Steele. "Nosophen as a Substitute for iodo 
form." Chic. Clinic, May, 1899, p. 136. 

NEW BOOKS. 

Amer. laryngological society. — Transactions, 1899, V. 20, 
Society donor. 



74 THE PLEXUS. 

Checkley, Edwin.— Physical training, 1895. Dr. W. L. Ball- 
enger, donor. 

Conn. -Health, Board of.— Annual report, 1888, V. 11. R. I. 
Medical Soc, donor. 

Flint, Austin. — Ausculation and percussion. Ed. 3, 1883. 
Dr. W. L. Ballenger, donor, 

Flint, Austin.— Diseases of the heart. Ed. 2, 1870. Dr. W. 
L. Ballenger, donor. 

Knapp, P. C. — Intra-cranial growths, 1891. R. I. Medical 
Society, donor. 

Martin, E. S. Hare, H. A. — Surgical treatment of wounds 
and obstruction of the intestines, 1891. R. I. Medical Soc, 
donor. 

Reynolds, J. E. — Experimental chemistry, 1886. San Fran- 
cisco. — Health, B"d of. Annual report, 1898. Board, donor, 

U. S. — Agriculture, Dep't of, — Yearbook, 1899. Gov\ 
donor. 

U. S. Education, Bur, of. — Study of history in Amer. colleges 
and universities, 1887, R, I, Medical Soc. donor. 

U. S. Marine Hospital service — Annual report of Supervising 
Surgeon-General, 2 V. 1885, 1887, R. I, Medical Soc, donor, 

U, S. Medicine and Surgery, Bur of. — Sanitary and statisti- 
cal reports of Surgeon- General of Navy. 1882, V 6. R. I. Med- 
ical Soc. donor. 

REPRINTS AND JOURNALS. 

Dr. A. J. Behrendt. — One box journals. 

Dr. G. G. Lewis. — Reprint. "Otology; its relation to gen- 
eral medicine.*" 13 p. 1899. 



BOOK NOTICES. 

One of the recent books which has come to our table is one 
of considerable merit. A Text Book of Anatomy by American 
Authors is the title, edited by Frederick H, Garrish A. M., M. D., 
Professor of Anatomy in the Medical School of Maine, Bowdoin 
College. 

An important feature of this work is its many illustrations 
in black and colors, there being 950 engravings in the book. 
The list of authors includes such men as Arthur D. Bevan, 
M. D., Professor of Anatomy at Rush Medical College; Wm, 
Keiller, F. R. O. S., (Edinburg) Professor of Anatomy in the 
University of Texas; Jas. P. Mc Murrich, A. M., Ph. D., Pro- 
fessor of Anatomy in the University of Michigan; Geo. D. Stew- 
art, M. D., Professor of Anatomy in the University and Bellevue 
Hospital Medical College, New York City; Geo. Woolsey, A. B., 
M. D., Professor of Anatomy and Clinical Surgery in Cornell 
University, Medical College, New York City. 

Another very commendable feature of the work is the illus- 
tratittg of the relation of anatomy of the internal to the external 
parts, plane sections showing the relation of internal struct- 
ure to eiach other and skiagraphs of the normal parts. It is 
thoroughly practical and a book which will compare most favor- 
ably with the long standard text books on this subject. Pub- 
lished by Lea Bros. & Co. Price, clo. $6.50; Wateri)roof $7.00 
Full sheep Itt". 50 net. 



THE NEWEE REMEDIES: By Virgil Coblenz, A, M., Pliarm., M.^ 
Pli. D., F C. S., Prof, of Chemistry and Physics in the N. Y. College 
of Pharmacy, has recently appeared in its third edition. 

It is necessary for the physician as well as the apothecary 
to keep informed concerning the newer remedies, and the con- 
venient arrangement and classification of these new drugs with 
their synonyms leaves little to be desired in this line. We find 
this edition much enlarged and arranged with the handy cross- 
references which makes it a great saving of time and trouble in 
gaining desired information. 

Published by P. Blakiston's Son & Co. Price, $1.00, net. 



FUN AT THE DOCTOR'S EXPENSE. 

"What do you find the most common delusion among you^ 

patients, doctor?" 

"That we physicians care nothing about having our bills 

paid." 

p. s. — This can be made a^jplicable to subscriptions. — Ed. 

She swallowed a cent and the thought of it shocked her, 

So straightway she hurried to call on a doctor, 

Who treated her case and demanded his money, 

When she coughed up two dollars. Say, wasn't it funny'?— L. A. W.. 

Doctor: You must give up drinking and — 
Mr. Sickly: I never touch a drop. 
Doctor: And stop smoking. 
Mr. Sickly: I don't smoke. 

Doctor: Humph! that's bad; if you haven't anything to give 
up, I'm afraid I can't do much for you. — Tid-Bits. 

"I had a strange dream the other night," said the surgeon. 

"What was it':'*' asked the Young Thing. 

"I went to Heaven, and as an old practitioner was interested 
in their clinics up there. They were a miserable farce, not a 
scientific operation in the blooming place, and I told St. Peter 
so." 

"What did he say? 

"He said, 'it's not our fault. We never get any good sur- 
geons up here.' " — With apologies to the PliUadelphia Press. 

Hogan: "Fwat makes yez swally all your dinner in less than 
tw^o minutes':' Are yez atin' on a bet":"'' 

Grogan: "I ate thot way fer the good av me dyspepsia. 
The docther tould me Oi ought to rist an hour after atin', an'how 
else am Oi to git the toime to rist in. fwin the whistle blows at 1 
o'clock again 'r^'" — Ex. 

An Ohio Doctor says that hay fever is caused by kissing 
grass widows. A Missouri Doctor says it is caused by a grass 
widow kissing a fellow by moonlight. An Iowa doctor says it is 
caused by the fellow kissing the girl while he is feeding hay to 
the cow, and an eastern Kansas Doctor is of the opinion that it is 
caused by missing the girl and kissing the cow. A poetical Doc- 
tor says that it is caused by kissing in the heyday of youth. — 
Payson Times. 




JOHN B. MURPHY, A. M., M. D. 
Professor of Clinical Surgery, College of Physicians and Surgeons, 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 

UNIVERSITY OF ILLINOIS. 



VOL. V. JULY 20th, ISaP. NO. 3. 

CLINIC BY DR. J. B. MURPHY BEFORE CLASS OF 

CHICAGO CLINICAL SCHOOL AT ALEXIAN 

BROS. HOSPITAL. 

Reported by Dr. A. F. Austin, Resident Surgeon. 

HERNIOTOMY. 

Case I. — J. G., aged 54; single; Irishman; entered hospital 
May 11th, giving history of having noticed a bulging in left 
inguinal region some five months previous, of sudden onset; no 
pair, but giving occasionally some discomfort. Examination 
shows presence of left oblique inguinal hernia extending down 
into the scrotum for a distance of 3 cm. Reducible. 

Twenty-four hours' preparatory treatment, systemic and 
local — as catharsis, baths, shaving, scrubbing, ether, alcohol, 5 
per cant, carbolic and a 1 to 3000 bichloride compress placed on 
the abdomen to remain until time of operation. Chloroform 
anaesthesia. (Modified Bassini Operation:) 

1. Incision 10 cm. long parallel to Poupart's ligament and 2 
cm. above. 

2. Division of aponeurosis of external oblique where fibres 
diverge and exposure of Pouparfs ligament, disclosing external 
ring, 

3. Separation of contents of canal from its wall . 

4. Tying out cord and all structures in the canal, 

5. Separation of sac, opening and reduction of contents with 
.ligation (with catgut) at internal ring. 

6. Amputation of sac and returning stump to abdomen. 



78 THE PLEXUS. 

7. Reduction of size of cord, by removal of cremaster muscle, 
numerous veins, adipose fascia and fattj^ tissue. 

8. A removable silkworm gut suture with guard of gauze on 
end was passed through the skin and external oblique at upper 
angle of wound. A continuous quilting suture of the lower 
portion of Pouparfs ligament, the internal oblique, and trans- 
versalis muscles and conjoined tendon was made with this suture, 
and the end brought out through the skin at the lower angle of 
wound and retained there. 

9. Cord replaced in canal, and the external oblique and 
Pouparfs ligament closed over it by a silkworm gut suture, both 
ends of which were retained externally so that the suture could 
be subsequently withdrawn. 

10. The skin was closed by a subcutaneous silkworm gut 
suture which was also removable. This method of approximation 
of the pillars relieves us of the xiecessity for buried suture mate- 
rial. It has been used frequently by Dr. Lee, but it is too soon 
to speak of the cures by the method, 

11. Collodion dressing applied. 

Theg:uarded silkworm gut suture will be removed at the end 
of ten days. 

RESECTION OF KNEE JOINT. 

Case II. — Wm. P., aged 23; single; American; entered hos- 
pital March 16. Gives history of previous specific and tubercular 
troubles. Has hai trouble with knee for past thirteen moaths, 
beginning simply with a feeling of stiffness, with little pain, in 
the morning some swelling, and a gradual disinclination for 
use, especially flexion. Knee joint has been tapped three 
times with negative results. 

Constant treatment by various methods, injections, massage, 
immobilization, etc., for past year failed to give any relief. 

Diagnosis: Tubercular arthritis originating in internal tuber- 
osity of tibia. Resection advised. The patient stated that he 
preferred an amputation and use of an artificial limb than to 
have the knee in its present condition. He was persuaded to 
permit a resection of the knee, as it involved less danger to his 
life and promised a more serviceable and practical limb. 

Thirty- six hours' preparatory treatment, systemic and local, 
as in Case I. Chloroform and ether anesthesia. 

1. Subpatellar U-shaped incision from outer to inner condyle 
of femur. 



(^inic—Marphy. 79 

2. Division of ligamentum patellas and. reflection of flap. 

3. Removal of patella and all of the greatly thickened syno- 
vial membrane, with division of crucial ligaments. 

4. With saw a ^-inch section removed from lower end of 
femur, an:l a similar approximating level -mide by remaval of 
a half -inch section from upper surface of tibia. A tubercular 
focus was found extending half an inch below the sawed surface 
of the internal tuberosity of tibia. It was removed with curette. 

5. Approximation of the two bony surfaces by insertion of 
two silver wire sutures. 

6. Approximation of quadriceps and patellar tendons by 
heavy interrupted catgut sutures. 

7. Torsion of bleeding vessels and approximation of .skin by 
continuous catgut suture, leaving small opening at either angle 
for drainage. 

H. A very loose occlusive dressing was applied to the knee, 
enveloping the entire limb from nates to ankle, and over this 
was placed a circular plaster of Paris dressing, to remain for 
three weeks if no temperature develops. 

These dressings will be removed then, and a .second circular 
coat will be applied for another three weeks, or until a sufticient 
bony union has been secured. My results in excision of the knee 
for tuberculosis have been so gratifying that I never resort to 
amputation except where there are multiple sinuses with mixed 
infection and the soft parts are very much infiltrated. In upward 
of eighty cases of this class I have had but one death; that from 
meningeal tuberculosis five weeks after operation, and in no case 
have I had to perform a secondary amputation. 

AMPUTATION NEUROMA. 

Case III. — D. S. ; age 44; married; American farmer; entered 
hospital May 10th; gives history of having had left hand caught 
in the cogs of a thresher tw^o years ago, with result that amputa- 
tion just above the wrist Avas necessary. Ever since the wound 
has healed the end of the arm has been very painful, pain being 
referred to the thumb and little finger, especially. Cord and 
stump sensitive to touch and pressure. 

Preliminary preparation for twenty-four hours. Chloroform 
anassthesia. Incision on palmer surface of wrist from end of 
stump upwards for a distance of 8 cm. Median and ulnar nerves 
found involvai in a praLif3rjibiv^3 pro3355 ani the eads 
gradually clubbed and enclosed in a mass of scar tissue. 



80 THE PLEXUS. 

Nerve ends were carefully separated upward and inserted,, 
for a distance of 4 cm., and amputation as shown in Fig. 1. Two- 
sutures were inserted in each as shown in Fig 2., and when tied 
the ends appeared as in Fig. 3 By this method end neurons 



Fig.l 




Fig. 2. 

— * 



~-^m 



Fig. 3. 

are brought in contact with end neurons. Their union is there- 
fore accomplished with the smallest intervention of connective 
tissue, lessening the likelihood of subsequent connective tissue 
reproduction. I have used that method in amputation of laige- 
nerves for a period of three years. Wound closed without 
drainage, by continuous silk worm gut sutures, which will be 
removed in 7 or 8 days. Dry, sterile gauze dressing. 

PNUEMOTOMY FOR ABSCESS OF LUNG FOLLOWING INHALATION 

OF PEANUT. 

Case IV. — G. F., age 17; single; newsboy; American; entere.l 
hospital April 3, 1899, with following history: 

A week ago while running errands and eating peanuts, acci 
dentally drew into his trachra a piece of peanut shell. Taken 
with a serious coughing spell but could not dislodge shell, and 
instead it seemed to go farther down; next day had a severe 
chill followed by fever and continuous coughing; no appetite, 
and since the third day has coughed up a yellowish, purulent 
expectoration. On entrance had high temperature, cold sweats, 
flushed cheeks, coated tongue, aud constipation. Examination 
showed marked fullness over right lower lobe, especially poster- 
iorly, increased fremitus, mucous subcrepitant rales and a few 
rales in lower j)art of left lung. 

April 19th patient was examined by Dr. Murphy, who found 
fullness varying to flatness over posterior part of right lower 



S W 



o ^ 




Clinic — Marpliy.. 81 

lobe and over an area 5 inches in diameter. Friction sounds. In- 
creased fremitus; absence of respiratory sounds; mucoid rales 
around consolidated portion. Large quantities of pus expector- 
ated, especially at night; hectic fever for past ten days. Special 
examination April 6th, no tubercular bacilli. Pus cocci. Diplococci. 
Negatiye except small amount of indican. 

Patient removed to surgical department for operation May 
14th. Preliminary preparations for 24 hours. Chloroform an- 
agsihesia. Incision along lower border of seventh rib, poster- 
iorly in mid scapular line, through skin and muscles to rib. 
Retraction of tissues to allow of rejection of periosteum. Re- 
moval of a section of the rib 4 cm. in length, care being taken not 
to perforate the parietal pleura. Consolidatedpneumonic area 
■can be palpated through pleura, and the heavy, chromosizecl cat 
gut sutures are inserted through muscles, pleura and opposing 
portion of lung, anchoring the latter to pleura to prevent ret- 
raction of lung. Pleura incised, and portion of lung brought 
out infarct grasped with vulseelum forceps, through the open- 
ing, and fastened to surrounding tissues by cat gut sutures. 
The adhesions were very friable, and separated immediately 
after opening the pleura. Lung packed around with iodoform 
gauze and acclusive dressing applied to avoid adhesions, tirm 
enough to allow cavity to be opened externally in safety or a 
spontaneous discharge of abscess to occur. 

When the inflamed area was drawn through the incision the 
}ms emptied in large quantities from the mouth and was inJialed 
into the opposite lung, notwithstanding he was placed almost 
on his face. This produced a pneumonia of the previously 
healthy lung, from which he died on the third day. Cases of 
this class I will treat in the future as I am treating a patient at 
the present time, by first compressing the lung with interplural 
nitrogen injections, emptying the cavity, and if it does not heal 
after prolonged compression I will make a resection with 
external drainage, and will not have the danger of inhalatiou 
pneumonia. 

AMPUTATION OF THIGH FOLLOWING PENETRATING INFECTING 
WOUND OF KNEE JOINT. 

Case V. — A. K., Age. 17. single. Factory boy. American. 
Ent-ered hospital April 2, 1899, with history of having accidentally 
penetrated the knee joint with a hatchet five days previous. 
Examination of wound showed the joint to be infected, very 



82 THE PLEXUS. 

painful, swollen, red. and pus discharging from a cut above the 
patella. Fluctuation produced posteriorly and on the outer 
aspect of joint. 

OPERATION. 

(April 4th, 1899). Forceps were inserted through the 
original opening showing a diffuse phlegmonous infection of 
the -joint. Openings were made and through and through 
drainage secured with a rubber drain. No improvement 
followed. 

(April 1st). Joint cavity more thoroughly opened up. 
Patient in extreme septic condition. 

(May 1). Daily irrigation and hot applications — produce 
slight if any change for better. 

(May 11). General septicasmic condition developing high 
• temperature — ansemia, diarrhooi, great emaciation, frequent 
chills, multiple abscesses abov^e and below the joint. It was 
decided the only means to save his life w^as amputation. 

(May 15). Prepared for operation. l,00i* c c normal salt 
solution infused subcutaneously immediately before operation. 
Chloroform anaesthesia. Esmarch's bandage. Anterior and 
posterior flaps were formed in middle third of thigh. Muscles: 
cut through circularly. 

Periosteum reflected. 

Femur sawed through. 

Vessels ligated after the special method I have adopted of 
ligating near the end of the vessel then crushing the artery on 
the proximal side of the ligature with the needle holder, this 
produces a fracture of the intima, which is followed immediately 
by a thrombosis and prevents a possible secondary hemorrhage 
when the ligature is suppurated. I found in my arterial experi- 
ments four years ago that within a few hours after injuries to 
the intima the leucocytes and blood plaques accumulated and 
adhered firmly to the injured surface. This led to the plan 
adopted by me in amputations since that time, as we know^ that 
primary adhesions of the intima is slow and in many cases there 
is no thrombosis formed at the point of ligation. Nerves 
re.sected and approximated and the end treated as in Case III. 
Esmarch removed. 

Pressure and torsion of rem lining vessels. 
Perio.steum and mu.scles closed over stumjD in layers after 



Clinic — Murphy. 88 

plan of Neuver. Wound closed with interrupted sillv worm gut 
skin suture leaving space for drainage. 

Small gauze drains laterally. 

Sterile dressing. 

Saline infusion and bed elevated. 

The patient made a successful and uninterrupted conva- 
lesence. 

THORACOTOMY FOR EMPYEMA. 

Case VI. — W. A., aged 19; single; moulder; American; en- 
tered hospital May 9th with history of having had a double pneu- 
monia eleven weeks previous, but never perfectlyrecovered. 

Six weeks ago developed a pleurisy, which was first asj^irated 
four weeks ago. Since that time four quarts of fluid have been 
removed. He came here complaining of pains in side, cough 
worse at night, expectoration of large amount of muco-pus, 
night sweats, loss of weight and a fever. 

Examination shows flatness over whole left side posteriorly, 
Flatness anteriorly and in axillary regions below sixth rib. 
Diminished respiratory sounds below seventh rib. 

Absence of vocal resonance below sixth rib. 

Subcrepitant rales over left chest above sixth rib anddulness 
in apex. 

May 11th. Aspiration showed left pleura to contain a large 
amount of purulent material. Transferred to fourth floor for 
drainage. 

Prepared for operation. Chloroform ansesthesia. 

Incision made in 8th interspace back of axillary line, for a 
distance of three inches. 

Opening up pleural cavity with escape of some 500 c.c. of 
pus of a greenish-yellow color. 

A f-inch drainage tube inserted betw^een the rib,; and 
into the pleural cavity for a distance of some four inches, and 
held in position by a catgut suture. Dressings to be renewed as 
often as they are saturated, and no irrigation used. 

These cases are not irrigated in this hospital, as we believe 
they recover much more speedily and perfectly without. 

This is not a tubercular .empygema; it is a normal pneumonic 
empyasma without communication with a bronchi. A resection 
of a rib was not necessary. If it had been a tubercular empy- 
ema, or better an empyema with tuberculosis, the fluid could be 
allowed to remain a number of weeks or months to permit of the 



8-: THE PLEXrS. 

repair of the lung. Purulent fluids should not not be removed 
earl}' from j^atients suftering f rom tuberculosis, as it lessens their 
chances of recovery of the tuberculosis. 

THORACOTOMY FOR POST-PNEUMATIC EMPYEMA. 

Case VII. — W. L., aged 17; single; eevatorman; American; 
entered hospital May 14, 1899,wit'.i'history of seven weeks previous 
having had pneumonia with pleu] itic comx>lications. Examination 
on entering showed dulness to flatness over left lower thoracic 
region, absence of respiratory sounds, vocal fremitus and reso 
nance. Aspiration revealed presence of pus in left pleura. 

Patient prepared for operation. Chloroform anaesthesia. 

Incision made in eighth interspace and scapular line for dis- 
tance of 3 cm., oj^ening up pleural cavity, from which escaped 
some 250 c.c. of hcemorrhagic pus. One-fourth inch drainage 
tube inserted into cavity for depth of 3 cm. and retained by single 
silkworm gut suture. T)vj dressings applied as in previous case, 
to be changed dail}"; no irrigation. 

Cultures and microscopic examination were to be made of 
the pus. In cases of empyaema following pneumonia resest the 
rib early, unless the case be of long standing. Ample drainage 
can be obtained in acute cases without resection. 




W. E. GAMBLE, B. S., M. D. 

Lecturer on Ophtlialmalogy and Otology, College of 

Pliysicians and Surgeons. 



MEDICAL OPHTHALMOSCOPY. 
By William E. Gamble, B. S.. M. D. 

Lecturer on 0[ilitlialmol(),iry and Otology, College nf I'liysiciuns and 
Surgeons, Chicago. 

It had no doubt been known from prehistoric times that the 
■eyes of some animals glow in the dark. Various irrational 
exjjlanations had been offered. Prevost first noticed that a lumi- 
nous eye was never seen in an absolutely dark room. Broucke, 
in 1846, was the first to give a full explanation of the phenome- 
non, i.e., some rays of light that enter the animal's eye are re- 
flected back into the eye of the observer. 

The thought that it was possible to illuminate the fundus of 
"the eye, and thereby to see it, seems to have come first to Helm- 
holtz. In 1851 he gave to the world an instrument which he 
called the oi^hthalmoscope, by means of which "he does not 
doubt that all the pathological changes in the retina and vitreous 
humor so far observed in the cadaver can be seen in the living- 
eye, a fact which promises great progress in the little known 
pathology of this organ."" 

How well this projDhecy has been fulfilled the world well 
knows. 

For a time this instrument was considered a medical curios- 
ity, to be looked at but not to be taken seriously. The assistants 
to the masters began to use it, and it was not long before^ its 
utility was fully established. Guided and inspired by the mar 
velous discoveries of Graefe in the field of clinic observation, 
which were given to the woi'lcl in rapid succession, and by the 
equally classical work of Bonders in refraction, a great enthu- 
siasm in the study of the diseases of the eye was inaugurated 

It was the enthusiasm of the explorer in a newly found 
country; of a Drake, a De Soto or a Magellan. Heretofore the 
surgeon treated diseases of the eye. Ophthalmology as it then 
existed was but a department of surgery; 

The great interest in the newly found field of stud}^ segre- 
gated ophthalmology from surgery. It oecame an indei^endent 
branch of medical science. 



'"■"6 THB PLEXUS. 

This separation from all other departments of medicine has 
reached a greater extreme than that of any other specialty. The 
laity assume that an oculist is not capable of treating any other 
organ, with the possible exception of the ear. Not so with the 
laryngolcgist, the gynecologist, or any other specialist. Not 
long since I was told by an active, cap ible physician that he 
knew nothing about the eye and did not have time to bother with 
eye work, and yet this physician would treat anythingelse from an 
overloaded stomach to a laparotomy. This physician's statement 
fairly represents the attitude of our best as well as the poorest 
physicians toward ophthalmolygy. Why is this important organ 
so neglected? The eye is the window through which an invalu- 
able amount of information can be secured not .obtainable else- 
where. The explanation of this medical paradox lies partly in 
the fact that the student gets insufficient training in the use of 
the ophthalmoscope and in study of fundus cases. The day is 
near at hand when the old order will change. The use of this 
in.strument in the study of internal diseases of the eye to such 
an extent as to enable the student to make out gross lesions of 
the fundus, will be one of the requirements necessary to gradua- 
tion in the near future, I hope. Fundus findings are often the 
first evidence of disease in other organs of the body, e.g., ner- 
vous system, vascular system, renal organs, blood and constitu- 
tional diseases. This is the only place in the body where can be 
seen and studied: 

1. The termitiation of an artery and the commencement of a 
vein, with the blood circulating in each. 

'1. The termination of a nerve close to the brain, subject to 
many diseases that affect that organ. 

3. A nervous structure, the retina and a vascular structure, 
the choroid and ciliary body. 

The central artery of the retina being a terminal artery, 
embolism of this artery is occasionally found. It may be of the 
main artery or one of its branches. The presence of embolism 
of this vessel is often the tirst evidence obtained of grave cardiac 
lesion, e.g. : 

P. H., came under my care at the Illinois Charitable Eye and 
Ear Infirmary last April. Age 55. A laborer. Never been sick 
excepting an attack of typhoid fever fifteen years ago. Never 
had rheumatism; does not get out of breath on climbing stairs 
or other extra exertion. Became suddenly blind in left eye on 



Medical (JphfJia inoscoi y — (kiinlle. 87 

April 18th, 1899. Ophthalmoscopic examination showed embolism 
of central artery of retina. Examination of cardiac region re- 
vealed an aortic stenosis, which might have remained, undiscov- 
ered for an indefiiiite joariod had not the ophthalmoscope been 
brought into use. 

Embolism of this artery may be the first warning that is 
obtained of an ensuing cerebral apoplexy. 

Milictry aneurisms of the central artery are occasionally seen, 
and when found are conclusive evidence of a like condition in 
vessels of other organs, and consequently of great prognostic 
value. 

Alterations in the optic nerve head are of great importance 
to the general practitioner. These changes may ba grouped 
under two heads: 

1. Neuritis, increased vascularization with increased promi- 
nence of nerve head, accompanied by more or less exudate. 

2. Atrophy of the optic disc, shrinking of nerve head and 
decreased vascularity. 

Optic neuritis varies in intensity from hyperemia of the disc 
accompanied by slight blurring of the margins, by exudate, to 
complete blurring of outlines of disc, the exudate extending far 
out into retina, giving the appearance of nerve head being too 
large. The swelling extends forward into vitreous 1 to 3 milli- 
meters. The veins are much swollen and tortuous, the arteries 
small and can scarcely be seen. Usually hemorrhages are found 
in the nerve head. This is known as " choked disc," after Clif- 
ford Allbutt. All forms of. optic neuritis are due ts causes out- 
side the eye itself. In 80 per cent, of all brain tumors optic 
neuritis is present, usually the choked disc variety. This is con- 
sidered the chief diagnostic factor. 

In meningitis a majority of the cases have this symptom. In 
the early stages of this disease the alteration of the optic nerve 
may serve to distinguish it from typhoid fever. 

In abscess of brain choked disc is usually found. The optic 
nerve is often implicated in cerebral syphilis. Chronic dirturo- 
ance of nutrition, as lead poisoning, of ten produce optic neuritis 
of mild type. Anemia of young girls is often a cause of this 
condition. The administration of iron promptly relieves this 
condition. 

Under many circumstances the fibers of the ojDtic nerve 
undergo wasting or degeneration. I will only mention one group, 



S8 Tin-: I'LEXrS. 

known as the " si^inal atrophies.'" This form is of gieat x^racti- 
cal imi^ortance. The best example is found in the locomotor 
ataxia. In about 14 per cent, of tabetic cases the gray atrophy 
of tlie optic disc is an early symxitom. It frequently appears 
before incoordination develoi^s. Kahler observed this change in 
the*:lisc seven years, Charcot ten years, and Go wer fifteen and 
twe:ity j^ears before other tabetic symx^toms develox^ed. 

It is xirobable that more than one-half of x^rimary atrophies 
of the ox3tic disc are associated with diseases of the sxjinal cord. 

The causes of retinal disease also almost always dex^end on 
organic lesions of organs outside of orbital cavity. An example 
of the latter is albuminuric retinitis, which occurs in x^robably 25 
X^er cent, of all cases of Bright's disease. Such findings are often 
tne first evidence of renal disease, which had x^reviously given 
rise to vague symx^toms, such as headache, digestive disturb- 
ances, etc., the albumin and tube casts ax^x^e^i'in? later. The 
retinal change in albuminuric retinitis is so characteristic, as a 
rule, that there is little chance for mistake in diagnosis. In addi- 
tion to the general signs of retinitis, such as haziness of retina 
and distension of arteries, it is x^cirticularly distinguished by the 
white x^atches in retina, u.sually arranged around x^ax^illa and 
about yellow sx^ot in a beautifully radiating manner, crown-like 
in ax:)X^earance, with the yellow sx:)Ot in the center. 

In diabetes a somewhat similar exudation is found in retina, 
but it is not arranged in such a definite x^-^ttern, and usually more 
hemorrhage is x^resent. 

In leucoemia, in addition to the general S3nnx3toms of inflam- 
mation of retina, there is occasionally found a characteristic 
feature — a light hue of the blood in retinal vessels In fact, the 
whole fundus reflex is of a light yellowish red, owing to the dis- 
coloration of blood in the general circulation. 

The retina in early childhood is attacked by a malignant 
tumor known as glioma retinae, wdiich grows very rax^idly, and if 
not early diagnosed breaks through the orbital tissues, leading to 
certain death of the child. 

Sarcoma of ciliary body and choroid can only be diagnosed 
early by means of the oxihthalmoscox:)e. It goes without saying 
that the earlier the diagnosis of these neoplasms is made and the 
enucleation of the eye x^erformed, the better is the chance of 
saving x^atient's life. 

The whole uveal tract, inc uding the retina, li, often danger- 



Medical Ojihihahnnscojitj — GambJe. ■ 89 

ously implicated in acquired syphilis, especially during the sec- 
ondary stage. Syphilis being primarily a vascular disease, the 
choroid and ciliary body are the tissues most fi'equently attacked, 
and as a result hyalitis soon develops. The floating bodies in the 
vitreous of a young adult or a person in middle life are very su.^^- 
gestive of syphilitic infection, and unless heroic antisyphilitic 
treatment is immediately administered and kept up until hyalitis 
and other active symptoms have disappeared, the patient is lia- 
ble to become hopelessly blind. These changes in the vitreous 
can only be made out by use of the ophthalmoscope. Occasion- 
ally the physician gets the cue to the etiology of obscure cases 
by noticing the retinal pigment on anterior surface of lens, the 
result of a former iritis which, rheumatism being excluded, would 
be good evidence of syphilitic disease. 

Chronic tuberculosis seldom affects the eye ground. Miliary 
tuberculosis occasionally attacks the choroid in the form of nod- 
ules — few or many. In obscure (;ases the discovery of these 
nodules clinches the diagnosis and clears up a condition that 
might have remained unknown for an indefinite period. 

I^ast, but not least, the ophthalmoscope serves a most useful 
purpose in the diagnosis of errors of refraction. The expression, 
"eye strain,'' is having a deeper signifieance to the profession 
each year. Evidence has accumulated and is rapidly accumulating 
to the effect that eye strain is at the bottom of the persistent 
headaches of school children, probably 80 per cent, of the head- 
aches of adults, and that it is often the direct cause of many 
functional neuroses, e.g , neurasthenia, hysteria, insomnia, cho- 
rea, and even epilepsy and nervous indigestion. It is not my 
purpose in this paper to enter into an exhaustive discussion of 
any of the subjects mentioned, but rather to give a glimpse cf 
the broad field that medical ophthalmoscopy covers, and thereVy 
to indicate to the general practitioner its great valu 3 as an aid in 
diagnosis. 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OP PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 
UNIVERSITY OF ILLINOIS. 



Editor, H. J. STEGEMANN, '02. Business Mgr. G. G. DOWDALL, '00. 

Class Editors: 

F. C. BLACKWELftER/OO. W. O. McDOWELL, '01. J. M. MEYERS, '02 



Faculty Department, Dr. W. A. Fusey. Athletics, 

Alumni, Clinical Department, E. A. Gansbl 

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Send all reraiitances and commuaications as to subscriptions and advertising to G. G. 
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themselves responsible for the safe return of MSri. unless sufficient stamps are forwarded 

EDITORIAL 

Dr. Louis .J. Mitchell, the alumni editor of the Plexus, has 
resigned from our staff. Dr. Mitchell has filled this position since 
the founding of the Plexus. There is no one in the alumni asso- 
ciation so capable of filling this position. His cast of mind, his 
training and his broad acquaintance with the institution and its 
graduates fit him for this position as no one else 'is fitted. The 
Plexus is glad to thank him for and sorry to lose his valuable 
services. 

' * * 

* 

A contemporary gives as a valuable health hint the following. 
"The best way to keep well is to remain in good health, and the 
best remedy for all ills is to avoid sickness."" It further tells us 
that "anybody who will observe these simple rules will never 
need a doctor." 

"When the laity become wise enough to observe these 



Editorial 91 



simple (?) rules what is to bacoms of the do3torsy L?fs not 
think about it. Let's live in hope. 



We wish to thank those who have so liberally responded to 
ourinvitationtocontributematterfor the columns of the Plexus. 
We are still anxious for other contributions of interesting matter. 
Short; spicy and entertaining articles are in demand. If you 
know of a specially good prescription for any disease; if you 
have any extraordinary cases coming under your notice; if you 
have anything that will interest the alumni or ihe profession at 
large, send it to us. 

* * 

Dr. Albert Schneider, of tlie class of '87, contributes the 
leading alumnus article this month. He is a member of the Fac- 
ulty of the School of Pharmacy of Northwestern University, 
having been apj^ointed Professor of Botany, Materia Medica and 
Pharmacognosy. 

He has done a surprisingly large amount of scientific tech- 
nical work, particularly in the field of botany. The majority of 
his scientific papers have been largely of a technical nature and 
hence of interest chiefly to specialists in the subjects treated of. 
These papers have been published in foreign as well as American 
scientific journals. 

Dr. .Schneider is the author of "A Text-book on General 
Lichenologj^"' just published, also, "Guide to the Study of 
Lichens," Bradlee Whidden, Boston; ' Hints on Drawing," En- 
gelhard & Co.; ': Microscopy and Microtechnique" (in press); 
"Powdered Drugs" (in preparation). 

Dr. Schneider was born at Granville, 111., April 13, iStiS. He 
graduated from the College of Physicians and Surgeons of Chi- 
cago, in 1887. During the years 1890 to 1894 he pursued courses 
of study in the Universities of Minnesota and Illinois, receiving 
the degrees of Bachelor of Science and Master of Science. 
During 1893 he was instructor in botany at the State University 
of Minnesota. In 1894 he was elected a Fellow in Botany at ^he 
Columbia University of New York, and held that position for 
two years, the maximum time allowed. In June, 1897, he received 
the degree of Doctor of Philosophy from that university. 



92 T IE PLLWC^S. 

It is with the greatest satisfaction that we hear the official 
announcement that Dr. Wm. E. Quine will continue his work as 
Dean and Professor of the Principles and Practice of Medicine 
and Clinical Medicine at the College of Physicians and Surgeons. 
Both student and school will be the gainer thereby, for no mm 
has done more for the upbuilding and advancement of the iater- 
ests of both than has Dr. Quine. and no man would be more 
sorely missed. He is the one to whom students have learned to 
submit their grievances, and he has endeared himself to them by 
his courteous and fair treatment on all occasions. As a teacher 
no man on the Faculty stands hinher than does Dr. Quine. Revere 
him they do for his skill as a practitioner, but it is as Dr. Qiiiie, 
the friend and teacher, that the graduate leaving the college 
holds him in greatest respect. 

The college is to be congratulated that they have been able 
to keep, as a member of the Faculty, such a man, who wins and 
holds the respect, admiration and love of every alumnus who 
goes from our midst. May there be many years left to him to 
continue his noble work of advancing the interests of the student, 
the school and the science of medicine. 

•K- * 
* 

The British Medical Jomnial of June 17 comments upon the 
recent address (The Secret of Success in Medicine) of Dr. John 
E. Harper as follows, "We learn from an American contempo 
rary that Dr. John E. Harper, in an address on "Success ir 
Medicine;"' delivered at the gr iduating exercises of the College 
of Physicians and Surgeons of ttie University of Illinois, pointed 
his moral by citiig the principles ai )pted b/ Sir H3ni-y HDlland 
for the conduct of his professional life." 

The two resolutions alluded to are: Fh'st, that he would 
never practice more than ten months in any one year, spending 
the remaining two months in travel and recreation; second, that 
he would never allow his practice to exceed £50,000 per annum. 
Though Sir Henry religiously observed these resolutions, he on 
several occasions came mightv near breaking one of them by 
exceeding the limit of t'50,000 set by him. 

The BriiUli MfdiculJounKtJ thinks that such resolutions would 
not be hard to keep, particularly the one limiting one's income to 
the figure set by Sir Henry, and further says: " We fancy that 
most people fully agree with Ur. Harpei- that the secret of fuccess 
in medicine is to make £50,0) ) a year." 



Editorial. 93 

Most doctors, however, would have great difficulty in attain- , 
ing such a marked degree of success, but would have an easy 
time of it in keeping within the limits of such a resolve. 

Speaking seriously, however, Sir Henry had exceptional 
advantages at the start. He lived at a time when a little knowl- 
edge went a long way; he had entree to the fashionable West 
End London, which was not open to every one, some having to 
be content with the haunts of Brixton or Stepney, or even of 
Whitechapel; he was considered rather more a neutral medium 
of unofficial gossip than a doctor, and it is on record that ' ' on 
his paying a visit one day he was informed that her ladyship wa& 
too ill lo see him." Thus did Sir Henry have an easy road to 
travel. 

The average young M.D. in this age finds that his path to 
fame and success is not strewn with roses. He lives at a time 
when the conditions are rather reversed; where a great deal of 
knowledge goes but a little way, and that Vhen his lady patients 
are too ill to be seen, he is expected to be able to restore them to 
health, that they may be the medium of unofficial gossip. Thus 
are the conditions reversed, and such a resolve as limiting one's 
income is decidedly not good form. ^ 

* 

Professor W. T. Eckley, Professor and Demonstrator of 
Anatomy, is a thorough believer in expansion and is putting his 
belief to a practical test. The doctor's mind is constantly on the 
alert looking for better ways and means of imparting his knowl- 
edge of the anatomy of the human subject to the students under 
him, and those who will take up this branch next year will cer- 
tainly be the gainers by the forethought displayed by Dr. Eckley 
in preparing for them special dissections and specimens for indi- 
vidual examination. 

The plans outlined by Dr. Eckley are now being carried out, 
and not only will the students ol anatomy be the gainers, but to 
the same extent will students in other branches be benefited. 

Special rooms have been fitted up for the exclusive use of 
Dr. Eckley and his department. As to the value of this depart- 
ment and the plans outlined the following examples will attest: 
Special dissections are now being made, comprising dissections 
of all the important organs of the body, as well as of muscles, 
ligaments, veins, arteries and nerves, which will be carefully pre- 



94 THE PLEXUS. 

served for use before the classes. Heretofore, a professer lectur- 
ing to a class has been content to illustrate his lecture by crude 
drawings, which, to say the least, has been very unsatisfactory 
in conveying an idea to the student's mind of the point involved 
in the lecture. In future, when, for instance, a professor lectures 
upon the circulation of the blood, say, to the lungs or to the 
liver, he will have before him, on a suitable tray, the special 
organ which is the topic of the lecture, dissected in such a man- 
ner that the exact course of the veins and arteries can be traced 
from their entrance to that organ to their exit; should a profes- 
sor of nervous anatomy wish to illustrate the course of a motor 
impulse, a special dissection of the nervous system will be at his 
disposal, showing plainly and truthfully the course of the nerve 
trunk and its branches, or should he wish to elaborate the course 
of any special nerves or plexuses, he will have at his disposal 
that part of the body containing them in their natural position; 
should a professor desire to illustrate an inguinal hernia he will 
have at his disposal that part of the body showing the canal, the 
cord, and all the parts involved in such hernia. Examples as 
above may be multij)lied many fold. Thus it is easy to see the 
great value of the department, and it is safe to say that few 
schools in this country will give as good or better course of 

instruction in anatomy than will this school. 

* * 

The eighteenth annual announcement of the College of 
Physicians and Surgeons of Chicago, the School of Medicine of 
the University of Illinois, session of 1899-1900, differs slightly 
from its predecessor. The fall term opens Monday, September 
18th, 1899, with the presentation of diplomas and certificates of 
scholarshii) for admission to the college. April 18, 1900, is the 
day set apart for the commencement exercises. On April 19th, 
1900, is the opening day of the last spring term that will be given 
by this college, it having been decided that the best interests of 
the students will be conserved by conducting a continuous course. 
Beginning the first Monday in September, 1900, the work of the 
college will be continuous. The collegiate year will be divided 
into three terms of four months each, beginning resj)ectively the 
first Monday in September, the first Monday in January and the 
first Monday in May, and called the fall, the winter and the sum- 
mer terms. Each term will consist, as nearly as possible, of a 
session of sixteen weeks. 



Editorial, 95 

Each student will be required to attend two terms of four 
months each, in order to receive credit for a year's time. A 
student may receive credit for no more than two terms' atten- 
dance in any calendar year. However, a student may attend a 
third term in any year, provided he has the permission of the 
Dean and the written consent of his physician, for which atten- 
dance he will receive no credit for time, but during which he may 
receive credit fqr work done. Four years' time, that is, atten- 
dance upon eight full terms, will be required for graduation. The 
shortest interval between a student's matriculation and his gradu- 
ation can not be less than three years and eight months. 

In addition to the change to the continuous course, the re 
quirements for admission have been materially increased, neces- 
sitating a higher degree of knowledge and ability of one contem- 
plating the entrance to the medical profession. 

The most marked changes in the requirements are the 
branches of composition and rhetoric, in which a deficiency of a 
satisfactory preliminary education is alw^ays made most apjjarent. 
The requirements in these two branches alone will do wonders 
in raising the standard of the profession, since they require cor- 
rect spelling, capitalization, jDunctuation, paragraphing, idiom 
and definition, and the elements of rhetoric. The candidate will 
be required to write two paragraphs of about 150 words each to 
test his ability to use the English language. 

In the branch of English literature each student is expected 
to have read certain assigned literary masterpieces, and will be 
subject to such an examination as will determine whether or not 
he has done so. 

By the enforcement of these two requirements the densely 
illiterate will at least be kept out of the medical profession. 

* 

Dr. G. F. Butler reflected great credit upon the College of 
Physicians and Surgeons and upon himself at the recent meeting 
of the American Medical Association. 

In a discussion concerning the merits of the many proprie- 
tary medicines now on the market, there seemed to be some doubt 
as to the cause of the greatly increasing use of these preparations. 

No one attributed it to any increased excellence of these 
mixtures, but there was a doubt until Dr. Butler arose and boldly 
declared that the extensive use of these preparations may be safely 



96 HIE PLEXUS. 

attributed to the ignorance of the practitioner of today regard- 
ing materia medica and therapeutics. So well did he uphold his- 
argument chat we do well to quote this notice, appearing in 
Merck's Archives for June: "Dr. George Frank Butler, professor 
of materia medica and clinical medicine in the College of Physi- 
cians and Surgeons of the University of Illinois, and an author 
well known to the profession at large, took a prominent part in 
the work of the section of m^ateria medica. No speaker could 
command greater interest than he did, and none reasoned more 
soundly or had a more generous supply of facts on which to base 
his logic." 

As a proof of the favor with which Dr. Butler and his argu- 
ments were received, he was appointed chairman of a committee 
of five members to go to Washington in May, 1933, to revis3 the 
U. S. Pharmacopeia. This committee consists of Dr. Hobart A. 
Hare, Philadelphia; Dr. W. B. Hill, Milwaukee; Dr. F. E. Stew 
art. New York; Dr. R. G. Eccles, Brooklyn; and Dr. Butler. 



A DOCTOR S GOOD WORK. 

Next to the two great naval heroes of the recent Spanish 
war, Dewey and Schley, no man has displayed more honor and 
real merit than has Genei'al Leonard Wood. When the war 
broke out he was an unassuming doctor acting as an assistant 
regimental surgeon, but by virtue of his bravery and ability he 
rose to the rank of major-general, and when an able, thoroughly 
reliable man was needed to bring order out of chaos, and to 
snatch the living from the dead at Santiago after the surrender 
of that province to our forces. Gen. Wood was chosen. Most 
ably, loyally, faithfully, bravely and well has he discharged the 
duties of military governor of that province. 

At the time of his appointment, Santiago was one of the 
most filthy cities known to civilization, there being an average 
death rate of 200 daily. Gen. Wood's first step was to clean the 
city. This was carried on under most trying conditions — un- 
skilled workmen, lack of disinfectants, soldiers unused to manual 
labor, hunger and starvation on every side, and added to all 
these things a burning tropical sun. Yet in spite of these many 
disadvantages the cleaning progressed, food was provided from 
the scanty stores for those in actual need, and to-day a cleaner 
city is not to be found. The daily mortality has decreased from 



A Doctor's Good Work. 97 

200 to 10, and the discipline of the city has increased in a cor- 
responding ratio. All of these happy results are due to the 
promotion of a good man, a doctor with hard common sense, to a 
position of trust and authority, and the Plexus jaesitates not to 
predict that when the true historian tells the story of the Span- 
ish war, high on the scroll of honor among the great men taking 
part in that struggle will be the name of Leonard Wood. 

-» 

The Medical Profession and the United States 
Government. 

Under the above caption the A tiiprica n Gijnecological a nd Obstetri- 
cal Journal ably presents the just claims of the medical profession, 
and through them the entire people of the United States, to the 
advancement in the position and an increase in the powers of the 
Surgeon-General of the United States to that of a Cabinet port- 
folio. The recent Spanish war shows with what readiness the 
American people spring to arms in an answer to their country's 
call. The rich, the poor, the professional man, as well as the 
laborer and the man of business, all came forward to serve our 
common country in a manner worthy of all praise. With 
such an army no nation fails of attaining victory. Neither should 
a nation neglect to do-all in its power to preserve the safety and 
to maintain the comforts of its fighting forces, more especially 
when made up of men with such lo^^alty. The plexus therefore 
unites with the jourual in pointing the way to the betterment 
of the condition of the soldiers and sailors when in line of their 
duty. That there was a great defect some place during the last 
war in the matter of caring for the men in the service no well- 
informed person will deny. Had the Surgeon General been a 
Cabinet officer with powers equal to those of the Secretary of 
War and the Secretary of the Navy these terrible mistakes 
would never have happened, the plexus speaks not of these 
mistakes for the purpose of casting odium upon those responsi 
ble for the wrongs done the soldiers, but for the purpose of point- 
ing out the way in which such wrongs may be avoided in the fu- 
ture. 

In 1886 when the Secretary of Agriculture w^as raised to a 
Cabinet officer, many said' "Don't do it. Its w^rong, its extrava- 
gance," adinfinitum. Today no one doubts the wisdom of that 
step and while that was taken in the interest of the farmer, the 
agriculturist alone, this movement is in the interest of every cit- 



98 THE PLEXUS. 

izen of the United States. That which jDrotects the soldier 
strenghtens the Army, the sailor the Navy, and the strength of 
the Navy marks the power of the Nation. The coming Congress 
has much to do along these lines and no more important step 
could be taken, or wiser thing done than to promote the Surgeon 
General of the United States to the rank and pay of a Cabinet 
officer giving him a chair in the President's official family. 

THE ILLINOIS SOCIETY FOR THE PREVENTION OF 

CONSUMPTION. 
By W. a. Evans, M. D. 

This society had its direct origin in a communication sent to 
the Chicago Medical Society by Commissioner Reynolds. At his 
suggestion the Chicago Medical appointed a committee on tuber- 
culosis and this committee arranged the plans for the new soci- 
ety. The indirect origin lies in the almost world wide interest now 
existing on the subject. In nearly every land some organized 
movement is now on foot. The Berlin Congress was held in 
May. The English Society is to meet next month. The Ameri- 
can Medical association had their attention rivetted by the words 
of the President. They have appointed a committee who are to 
prepare a report on the nature of tuberculosis, its communicabil- 
ity and prevention, the more effectual means of controlling the 
sjjread of infection and of educating the jjeople in personal hy- 
giene s6 as to lessen the chances of their becoming tubercular 
and to increase the prospects of their recovering, the advisability 
of establishing state and national sanatoria and such other mat- 
ters as may be pertinent to the subject. 

And whyy One-third of the people w^ho die in the wage- 
earning years perish from tuberculosis. One-seventh of all the 
deaths are due to tuberculosis. It affects all races and every kinds 
of animal in which there are large property rights. It raises the 
expenses of insurance. It weakens subsequent generations that 
tuberculosis and other infectious diseases may enter. It leaves 
nothing untouched. "The trail of the serpent is over them all."" 

This society will first try to determine what it should do — 
then it will act to the limit that its means will allow. 




ALBERT SCHNEIDKF?. Pli. I) , M. 1). 



THE EVOLUTION OF MlND. 
By Albert Schneider, M. D., Ph.D. 

In general it is understood that evolution has application 
only to the material part of living organisms. For reasons to be 
given later the mind of these organisms, at least of man, is looked 
upon a S23iritual entity and is relegated to psychology. For con- 
venience of classification and investigation this distinction is both 
convenient and consistent. Nevertheless, the question remains, 
do these entities, physical and spiritual, actually exist y It is cer- 
tainly consistent with the modern scientific tendency to ask, what 
relation has mind to organic evolution and to evolution in gen- 
eral? Most biologists have thus far not expressed a definite opin- 
ion on the subject. They seem satisfied with discussing only the 
evolution of matter. The psychologists are quite unanimous in 
discussing mind as having an existence distinct from the material 
part of organisms though the two are supposed to be more or less 
intimately associated. Fornierly it was generally taught that 
man alone was honored with the gift of a spiritual ego. Within 
recent years grave doubts have arisen as to what this spiritual 
ego really is and whether perhaps after all some of the higher 
vertebrates are not also gifted with such an entity. But as 
already indicated nearly all psychologists are satisfied that man 
is endowed with such an entity. 

Before we can come to any conclusions in regard to the 
evolution of mind it is necessary to have some rational con- 
ception of the fundamental principles underlying a mental 
process. What is a mental process? What is its source? Upon 
what does it depend? In order to find the auvswers to these 
questions it is necessary to enter into a consideration of the 
origin of life, in fact with the origin of matter itself. The 
results of biologic investiagations indicate that all psychic 
phenomena are dependent upon and co-existent with the orga - 
nization of matter. 

Although evolution in general implies progress it must not 
be forgotten that it is accompanied by dissolution or retrogres- 
sion. Although the facts of evolution are evident, causal ' 
mechanical or final-causal explanation is at present impossible- 



100 Evolution of Jlind — Schneider. 

We must rest content with conclusions based upon very meagre 
data. Prom the study of individual cases we are led to believe 
that evolution as well as dissolution is primarily due to environ- 
ment. A correct conception of what is meant by environment 
will enable us to comprehend evolution. In general it is known 
that the composition, consistency, size, form and properties of 
all bodies are due to the influence of environment. One 
important fact must never be lost sight of and that is that every 
substance, whether it be living or dead, reacts upon its own 
environment, in fact forms a part of the environment. This 
leads us to another consideration and that is, before we can tind 
a final and conclusive explanation of the influence of environ- 
ment upon the substance in the aggregate we must comprehend 
the ultimate unit of structure whether that be the atom or some- 
thing else. Of this unit of structure we have only a theoretical 
knowledge and for that reason no final conclusions can b3 
given. 

Since we cannot know how and when the primary factors of 
evolution began to operate we must be content with knowing 
that they have been at work and have wrought great changes. 
Our special interest in the subject begins with the formation of 
living matter out of dead matter for with the primal bit of 
plasm came into existence the first manifestation of psychic 
phenomena. No one has as yet been able to explain the origin 
of the first form of living matter. Theoretically it is usually 
cxjilained something as follows: The reciprocal action and 
reaction of atoms, of molecules, of substances in the aggregate, 
of heavenly bodies, etc., finally converted dead matter into living 
organisms. Nor can it be supposed that the transition from 
dead into living was sudden. There were doubtless an innumer- 
able variety of intermediary substances. It is also reasonable to 
assume tliat this first life was essentially dift'erent from the 
lowest organisms now living since the environment must have 
been different 

Every substance, whether living or dead, possesses proper- 
ties peculiar to itself. We speak of substances with identical 
l^roperties, as for instance two granitp blocks from the same 
formation or two samples of water from the same spring. 
Strictly speaking their properties are not identical since it is 
impossible to make the environment ihe same in the relative 
cases. It is also known that the jiroperlies of matter are not 



THE I'LEXirS. 101 

interchangeable; that is a rock will never have the properties of 
water, nor the tree those of a man. The complexity and varia- 
bility of these properties are in direct ratio to the complexity of 
substances under consideration. To speak of the manifold 
activities (mental and physical) of man as properties peculiar 
to the substance may at first seem odd. Man scientifically con- 
sidered is nothing more nor less than a mass consisting of a 
multitude of specialized bits of plasm; each separate bit of 
plasm having properties somewhat different from its neighbor 
yet all working together harmoniously in their reaction with the 
environment. As soon as scientists can explain the movements 
and activities of the Amoeba they will also be able to explain the 
multitudinous activities of man. Some of the leading scientific 
investigators maintain that the activities of the lower organ- 
isms can be explained mechanically; that is their various ap- 
parently concious movements are simply the manifestation of the 
substances of which they are composed. In other words function 
is simply a property of living matter. All the evidence of 
modern specialists in botany and zoology goes to prove that 
function and structure are inseparable. Without organization no 
function could be and vice versa there could be no organization 
without a corresponding fanctian. 

It has been proven that plasm is not a "homogenious, viscid, 
translucent, semiliquid substance." It is the most complex 
heterogenius substance known to science, in fact altogejher too 
complex for even the most expert chemists. Its properties are 
peculiar and different from all other substances; chemically it is 
very unstable and this instability is supposed to account for its 
peculiar activities. It has also been demonstrated that the eel 
which was formerly considered to be the unit of living structure 
consists of several or more likely a multitude of living units- 
What the ultimate unit of living structure is has not yet been 
demonstrated. Investigations in this direction are constantly 
being made. 

It is quite evident that the various forms of plasm are 
different. The plasm of the Amoeba is as differeiU from the 
plasm of the nerve-cell as the psychic manifestations of the 
former differ from those of the latter. The plasm of the muscle- 
cell is as different from the plasm of the brain- cell as their 
relative activities. If the activities of the Amoeba and similar 
organisms are simply the manifestations of the properties of the 



1(^2 Evolution of Mind — Schneider. 

substance then it is highly probable that the activities of man 
are simply manifestations ct the properties of the multitude of 
cells acting- and rear^ting upon each other and with the en- 
vironment. 

Various and repeated attempts have been made to show that 
function preceeds organization. It is impirically assumed that the 
function came into existence first and by its action or influence 
upon matter caused the development of a corresponding organ. 
It is incomprehensible why a scientist should make such an 
attempt since it is in direct opposition to the results obtained by 
scientific investigations. A possible explanation of such ten- 
dencies is an unconcious atoempt to conform to the doctrine of 
dualism and to the popular nptiOn that mind dominates matter. 

According to the results of scientific investigations thus far 
obtained the following statements applicable to our subject seem 
to be deducable Function, inclusive of all psychic manifest- 
ations, and organization are one and inseparaljle. Change or 
modify the living structure and there is a dependent and corre- 
sponding change in the functional and psychic manifestations of 
that organism. With death the psychical manifestations cease; 
this is true whether the organism be Amoeba or man, tree or 
horse. The final conclusion then seems to be that evolution or 
mind is one and inseparable with the evolution of matter. 



CLINICAL LABORATORY DEPARTMENT. 

W. E. COATES M. D. 

Parasitic Origin of Tumors. — 

No subject at the present time is receiving more careful in- 
vestigation than that of the parasitic origin of tumors. 

Results so far obtained by European and American investi- 
gators lead us to believe that the day is not far distant when 
much light will be thrown upon the vexed question of wiiat is 
the determining cause of carcinoma, sarcoma, etc. 

The theory of perverted tissue proliferation without an ex- 
ternal and exciting cause is rapidly falling to pieces. Misplaced 
embryonal tissue elements that lie dormant for years, only to de- 
velope at some late period of life into a carcinolna or sarcoma — ■ 
this theory too must give w^ay to the later and in many instances 
proven theory, of the parsitic origin of neoplasms. 

If parasitic in origin, then what parasite or parasites are to 
be held responsible y 

Are w^e to look for the cause among the myriads of low forms 
of vegetable life, or among the equally numerous low^ forms of 
animal life? Opinions differ, one class of workers holding to the 
former view, another and probably more numerous class holding 
to the latter. 

Upon what observations or facts is the theory of the parasi- 
tic origin of tumors based? To attempt a full answer to this 
question would be a task too great for the present writing, inas- 
much as reports of investigations are daily accumulating. 

Suffice it to say that there are two "schools of opinion" — 
both schools agreeing that tumors are of parasitic origin, but dif- 
fering in that the older and more numerous school holds that the 
foreign bodies constantly found in neoplastic growths belong 
among the sporozoa, or similar species of the protozoa, a group 
of animals occupying the lowest place in the animal kingdom. 

The pathological literature of the last twenty years contains 
many able and well written articles on the parasitic origin of 
neoplasms, in wiiich the writers seem by common consent to have 
placed their faith in the protoroan theory of the origin of tumors. 



104 THE PLEXUS. 

Space and time will not permit of more than a brief mention 
of the protozoan theory, well and ably supported as it is by ajD- 
parent facts, the object of the present article being to direct at- 
tention to the vegetable fungi as a probable, and in some instan- 
ces a proven cause of certain t^'pes of granulomata, neoplasms, 
etc. 

Bosc, one of the latest advocates of the protozoan theory, 
in a recent monograph of 250 pages entitled ''Le Cancer Maladie 
Infectieuse a Sporozoaires" Carre et Naud, Paris, 1898, sums up 
the entire subject of the histogenesis of cancer by stating that it 
is merely a proliferative and hypertrophic process due to the ir- 
ritating ciuality of the j^arasites (sporozoa) upon the tissue. 

The sporozoa, according to Bosc, appear in a variety of 
forms: — 

I. Microbe-life form, very small, occuring isolated and in 
chains. II. Granular form, larger than the preceeding. III. 
Cellular form, still larger. IV. Encysted. V. Sarcodic form. 

These five forms are illustrated by Bosc. He decides that 
the sporozoa of cancer and sarcoma are identical. 

According to Bosc, the sporozoa may occur outside of and 
between the cells, or within the cell (rarely within the nuclei). 
Cultures of these sporozoa were obtained and animal experiments 
carried out. For further details of Bosc's work see monograph, 
also extract in Medical Review of Reviews, page 428, June 25, 
1899. 

Bacteriological workers have looked in vain for a bacterial 
cause of neoplasms, but within the last five years success has ai3- 
apparently been attained in many instances by the European and 
American workers who have departed from well beaten paths 
and sought for a cause among the higher or true fungi. 

Among the European workers on the parasitic vegetable 
fungi present in neoplasms, granulomata, etc., must be men- 
tioned Kahane, Sanfelice, Roncali, Binaghi, Mafucci, Sirleo, Rus- 
sel, Busse, Buschke. Curtis, H. Roger, Bra, Rabinovitscb, and 
Braithwaite. 

In America interesting and valuable contributions to the 
subject of blastomycetic fungi have baen made by Park of Buf- 
falo, Gilchrist and Stokes of Baltimore, Hektoen and Wells of 
Chicago, and Hessler of Indianapolis. 

The cases roi)orted by Gilchrist and Stokes, Hektoen, Wells, 
and Hessler have been reported as cases of "Blastomycetic Der- 



CI ill teal Laborafoi'ij Departinent — Coates. ICS- 

matiiis" and from their discriptions should be placed among the 
granulomata. 

At the May, 1899, meeting of the Chicago Pathological So- 
ciety, the writer reported a case of blastomycetic tumor of the 
lip which, while it corresponded to the reports of cases by Gil- 
christ and Stokes, Wells and Hektoen, yet differed from their 
cases, in that the writer's case, clinically and histologically, was 
an epithelioma. 

(To be continued.) 



0/ infra I Lahoratorii Lihrarij. — 

The plan of establishing a laboratory reference library for 
the use of students making a special study of clinical laboratory 
work, as mentioned in the June "Plexus,'' has met with the ap- 
proval and co-operation of a number of the faculty and of Miss 
Bryant, the college librarian. 

A start has been made by placing in the laboratory about 
twenty live duplicate volumes from the main library of the col- 
lege. 

Members of the faculty, alumni, or others interested, are 
urged to contribute works or reprints of articles bearing on labor- 
atory medicine. Pathological society reports, back files of stan- 
dard medical journals containing interesting articles on pathol- 
ogy, histology, bacteriology, embryology, biology, etc., will be 
an acceptable and valuable aid to the work of the laboratory. 

Next to the need of standard books is the need that can only 
be filled by subscriptions to the best pathological, bacteriologi- 
cal and microscopical journals. 

Donations or loans of books, journals, reprints, etc., or con- 
tributions of money for the purchase of laboratory manuals or 
current literature, can be sent ' to the Clinical Laboratory 
Library in care of Miss Grace W. Bryant, College Librarian, - 
who will see that proper disposition is male of books or money so 
received. 



Laboratory Research. — 

The amount of pathological material available to under- 
graduate or graduate students competent to conduct research 
work should stimulate a deeper interest in orginal investigation. 

The system of laboratory index and history cards recently 



106 THE I'LIJXrS. 

inaugurated will render it possible for a student to devote his 
time to any special line of investigation, placing at his disposal, 
not only the results of his own work, but the records of similar re 
search or examinations previously carried out in the laboratory. 

Gross and microscopical specimens are all carefully indexed, 
histories and microscopical findings written up for each specimen 
of tissue, sputum, urine, blood, etc., sent in for examination. 

With the development of the Clinical Laboratory Library, 
will come an index system for all articles in the standard refer- 
ence works and journals pertaining to laboratory medicine. 

Let us hoj^e that the coming school year will witness an in- 
creased interest along all lines of orginal investigation at the P. 
& S. 

NEWS ITEMS. 

Dr. Chas. A. Albrecht, '99, reports that he is getting a good 
service, as interne, at the Norwegian Lutheran Hospital up on 
the Northwest Side. 

We have been requested to announce to the Quiz class for the 
year ■99-"()(:) that their work will begin Sept. 1st, 1899. 

Mr. N. M. Verry, our genial superintendent, is at present 
enjoying the benefits and pleasures of a summer vacation at his 
old home in Madison, Ind. Mr. Verry carries with him all our 
best wishes for a very enjoyable visit, and we expect him to 
return with many pleasant stories of how they enjoy life in the 
South, even in the summer time. 

Monday evening, June 12th, the graduating exercises of the 
West Side Hospital Training School for Nurses were held in the 
amphitheater of the college. Dr. D. A. K. Steele presided and 
Dr. J. B. Murphy delivered the address of the evening, embody- 
ing in a very pleasing talk much good advice to the thirteen 
graduating nurses. A musical program was also rendered which 
was thoroughly enjoyable. After the presentation of the dij^lo- 
mas a reception was held on the lower floor and a stringed band 
furnished music for those who cared to dance. The decorations 
were charmingly arranged, the yellow and white, the class colors, 
being shown in wreaths of daisies wound about the refreshment 
tables. Mrs. Annie Hewitt Byrne, who then entered upon her 
new duties as head of the training school, proved herself to be a 
most pleasant hostess, and the evening was greatly enjoyed by 
all so fortunate as to be present. 



HOT WEATHER CARh OF INFANTS AND YOUNG 

CHILDREN. 

Prepared by F. W. Reilly, M. D. Assist. Commissioner of Health, Chicago. 

Out of every 100 deaths in the City of Chicago, for some 
years past, 45 are of young children under 5 years of age. Of 
these 45, two-thirds are of babies — infants under one year of age. 
And more than one-third of these infants and young children die 
in the two hot summer months — July and August. 

The weather can't be changed but proper feeding, suitable 
clothing, cleanliness and fresh air will do much to make baby and 
child live more comfortable, to ward off sickness and to 2:)revent 
death in any weather. The following advice is offered by the 
Department of Health for this purpose. 

Heat kills off babies and young children largely because it 
spoils their milk and other food quickly. Even breast milk 
when the mother is overheated, may give the baby colic or sum- 
mer complaint." If a mother is very hot she should draw a 
teaspoonful or so from the breast before nursing her baby. If 
the breast has not been given for, two hours or more it should be 
drawn off in the same way. And \f the mother has been badly 
frightened or very angry or excited, it is not safe to give the 
breast at all; it should be drawn and the milk thrown away. 

The proper food for babies is mother's milk. — No sensible 
mother needs advice on this point. If she is fairly healthy her 
breasts will give all the nourishment the child should have until 
it begins to cut its teeth — the sixth or eighth month. IJp to this 
time it is a sin to give an infant one morsel of solid food of any 
kind, or anything but breast milk (if the mother is healthy) ex- 
cept water in very small quantity occasionally, but never soon af- 
ter nvrsmg 

Many infants are killed every year by bringing them to the 
table with the family and giving them a little bit of this that 
and the other; meat, vegetables, pie, pickles, etc., which the lit- 
tle stomach is not fitted for. They are '^killed" just as surely 
though not so quickly, as if they had been fed poison out of a 
drug store. 

When the baby that is fed this way sickens and dies it is 
called "diarrhea," or "dysentery," or "cholera infantum." or 



los THE ritwu^. 

"summer complaint," or "teething-/' or convulsions," or "brain 
fever." But these are only names for the result of poisoning 
with unfit food. 

Wait tillthe baby gets teeth before you put food into its mouth that 
needs to be cheioed. 

If the breast milk gives out, or becomes thin and watery, or 
if the mother has consumption or any other long standing sick- 
ness, the baby must be put on the bottle and fed with cow's milk. 

Get the best milk you can atford and if it isn't good, or 
"sours"" too soon, or doesn't give enough cream, send word to the 
Health Office in the City Ball. Be sure to give your name and ad- 
dress and a milk Inspector will be sent to find out where the 
trouble is. 

As soon as the milk is receive! take what is to be used for 
the baby and "scald" it. Don't let it boil. 

A good way is to set a pan of cold water on the stove and 
put the vessel containing baby's milk into this pan; just as soon 
as the water comes to a boil take it off. This amounts to what is 
called "sterilizing" or "pasteurizing"' the milk. Add a pinch of 
baking soda to the hot milk — half a teaspoonful to a quart. 

If the milk was sweet and hadn't begun to "turn" when it 
was received it will keep sweet for twenty-four hours or more 
after being treated this way, even in hot weather. But, of course, 
it should be kept in a close-covered vessel, fruit jar or stoppered 
bottle. Whatever it is kept in should be thoroughly scalded^ — 
cover, stopper and all — before the fresh milk is put in it. 

If you have an ice-box or refrigerator to put the milk in, or 
can in any other way keep it from "turning," it is better to let it 
stand for about six hours and then pour off the upper half for 
the baby"s milk. This should then be "scalded" and soda added 
as before described. If you can't do this, a little cream should 
be added to the baby's milk — say one tablespoonful of cream to 
two or three of the milk. 

To make this nearly like breast milk take two cups of water 
that has been boiled, to each cup of milk and add enough white 
sugar to make it as sweet as breast milk. 

If this mixture is too rich the baby -'ill throw it up in curds 
or lumps, or it will pass through the bowels in white tiakes and 
shreds. If this happens add more boiled water to the mixture 
until you find just what strength the baby's stomach will stand — 
what it can digest. 



Hot Weather Care of Infantf^ — RelUii. 109 

When the baby is about a month old barley water should be 
used instead of plain water. Put two tablespoonfuls of pearl 
barley in four cups of cold water; boil an hour or more— down to 
two cups, strain through a close cloth; add a pinch of salt and 
sweeten with white sugar to breast milk taste. Add this to a 
cup of "scalded"' cow's milk treated as first described and begin 
feeding this strength, 

Gradually use more milk and less barley water, until at 
about six months of age the child is getting two-thirds milk and 
one-third barley water. 

Next to healthy breast milk this will make as good food as 
the infant can get during teething and w^eaning. Then comes 
the pure milk— always "scalded"'— bread and milk, baked potato 
and milk, oatmeal porridge— which can't be boiled too long, 
never less than two hours— s^nd. always eaten with milk, and the 
milk always "scalded," not boiled. 

Don't overfeed the baby.— Once in about two hours is often 
enough to suckle or feed a baby until it is four or five weeks old; 
after that do not feed them so often. 

When a baby is about six months old it will generally thrive 
best if fed only once during the nighji and four or five times reg- 
ularly during the day. It is bad for a baby's stomach and bow- 
els to feed it too often or too much at a time especially in hot 
weather. 

A new born baby's stomach will hold from two to three 
tablespoonfuls, and not more than this amount— rather less— 
should be given at a time during the first week or so of a bottle- 
fed baby's life. 

As the baby grows the quantity should be gradually in- 
creased, so that at the end of the first month it may be taking 
about four tablespoonfuls at a meal. Some children will require 
more and others will not stand so much — but there is more danger 
of giving too much at a time than too little. 

Don't stick the nipple in the baby"s mouth every time it 
cries. — If the baby is properly fed at regular times it won't get 
hungry enough to make it cry, and it is foolish to feed it when- 
ever it cries instead of trying to find out the trouble. It may be 
only thirsty and a few drops of cold water — not a big drink — will 
stop it; or its clothes may be uncomfortable, or its napkin need 
changing. 

Try to find out what makes it cry, and then use "mother wit.'" 



llO THE PLEXtlS. 

Don't feed the baby with a spoon. — Sucking is the natural 
way that a baby takes its food. It needs the sucking action of 
the lips and mouth and tongue to mix its food with the fiuids of 
the mouth and to keep it from getting into the stomach too fast. 

Spoon feeding doesn't do this; 

Use a plain common bottle for feeding, with a rubber nipple 
and no tube. 

Fancy nursing bottles, with long rubber tubes and patent 
contrivances, besides costing money, cant be cleaned easily, and 
babies don't do well with them in other ways. The more simple 
the bottle and the nipple, the better for the baby The rubber- 
tube bottle is a device of the Evil One for lazy mothers. It's 
bad enough when a mother can't suckle her own infant at her own 
breast; let her at least take it in her arms and hold the bottle 
and "mother" it while it feeds. 

Take the nipple off after each feeding and wash both bottle 
and nipple with boiling hot water at once. Before using again 
rinse the bottle and nipple in clean water — about a quart of wa- 
ter — with half a teasjjoonful of soda in it; or keep them in a pan 
of soda and water when not in use. 

More babies get "sore mouth" and "wind colic'" and "sum 
mer complaint" for want of care of the nursing bottle than from 
any other one cause. A little stale milk around the neck of the 
bottle or in the nipple will set up a ferment which is poison to 
the delicate lining of a babies mouth and stomach. 

Of course the baby's bottle-food should be warm — about the 
same as breast milk, or "blood heat;" that is as warm as the in- 
side of the mouth. 

Keep the baby clean and it will stand the heat better. — When 
the thermometer is at eighty to ninety in the shade it isn't easy 
to keep the baby cool. But it can always be kept clean and will 
then be more comfortable and have a better chance of living 
through the hot weather. It should have at least one full bath 
every day and oftener during extreme heat. Never bathe within 
one hour after feeding it. Bathe first; feed afterwards. 

Dress as lightly as possible. It will be belter stark naked 
some hours a day during the hot weather when indoors. But 
keep it in the open air, out of the hot sun, as much as you can 
between sun rise and sunset. The out door air, even of a dirty 
street, is fresher and better than the air in the house. 

Fresh air is the breath of life in a baby's nostrils. Take it 



Hot Weather Care of Infants—Eeilly, 111 

or send it to the parks, or open squares, or the lake shore as often 
as you can. 

In the changeable cUmate of Chicago, care must be taken 
against sudden chilling. A thin soft flannel binder, wound two 
or three times around the body, will do more to guard against 
this chilling than the ordinary full dress or frock, vest, skirts, 
drawers, socks, etc. 

This binder should be only wide enough to cover the belly 
and inch or so above the navel and a couple of inches below. It 
should be wound smooth and free from creases or folds, and tit- 
ted with a fewi stitches of darning cotton — not pins. 

This binder' and a napkin are all the dress baby needs during 
the heat of the day in the house in summer. 

Do not let the baby sleep in the same bed with any other 
person. If there is no crib, the mother should put a couple of 
chairs at her bed-side, with any kind of covering on them — not 
feather pillows or hot woolen stuffs — and let. the baby sleep 
there. It will be more comfortable on a summer night than ly- 
ing against the hot body of its mother, and will not be so apt to 
disturb or be disturbed. 

The backs of the chairs will keep the baby from falling, and 
the mother can readily reach over to care for it when necessary. 

Do not drug the baby. — If after all your care, the baby should 
fall sick, do not "pour drugs of w^hich you know nothing, into a 
body of which you know less." 

There is no mother in the city of Chicago that cannot get the 
best of medical treatment for her sick baby without money and 
without price, if she is unable to pay. Call a doctor instead 
of spending money for patent medicines, "soothing syrups" or 
"cure alls," which will probably do your baby more harm than 
good. 

Although this advice is more directly for babies during the 
first year of life, the sense of it applies quite as well to older 
children. 

"Don't overfeed them, and don't let them overfeed. 

Don't give them rich food — meats, gravies, pastries, cake, 
etc. — nor a great variety. The simpler and plainer the better — 
plenty of milk, whole wheat bread, oatmeal, baked apples and 
fruit of all kinds, in season, ripe and fresh. Roasts and stews 
and made dishes and — ^Jie will come soon enough and so will dys- 
pepsia. 



112 THE PLEXUS. 

Keep ap the daily full bath until it becomes a fixed habit. 

Keep them out in the open air as much as possible the whole 
year round, and send them into the country whenever you can do 
so, but only to places cohere the ivater is pure. 

If a baby or child is worth having it's worth saving, and 
more than half of the babies and young children that die in Chi- 
cago every year could be saved by following the advice here 
given. 



Some 

of our advertisers v^^ill send you 

Something 
tor Nothing.., 



if you will v^rite to them, 
saying you saw their ad- 
vertisement in the Plexus, 



Do So 



•Alurppi Deparbmepb, 

The secretary of the Alumni Association is happy to announce 
progress in the work of bringing the alumni closer to each other. 
Through the leaflet sent out in June we have already received 
information of 200 alumni. This is over 17 per cent, of the entire 
number of graduates of the school. We hope that those of you 
who have not returned the information asked will do so as soon 
as possible. So many letters have been received that we can not 
divide them up. This month we publish all data as to '83, '84, '85. 
'86 and '87. Other letters will follow as rapidly as space will 
permit. 

'83. Walter Lovejoy, Kemmerer, Wyo. 

'88. Morris R. Weidner, Dolton, 111. 

'83. R. J. Morton, Green, Kan. 

'83. C. G. Roehr, 103 State St., Chicago. 

'83. H. S. Skinner, Shawnee, Okla. 

'83. G. E. Brinkerhoif, 1155 Broadway, Oakland, Cal., Pres- 
ident San Francisco Society Eye, Ear, Nose and Throat Sur- 
geons, for 1898. 
I ~ '83. J. A. Gafford, Shawnee, Okla. 

'83. R. J. Morton, Green, Kan., is 1st Vice-President Kansas 
Medical Society and member of the State Beard of Health. 

'83. Halsey E. Lovejoy, is President of Pension Examining 
Board, Green County, Iowa. 

'84. C. L. Barber, Albion, Mich. 

'84. Arthur H. Brumback, 100 State St., Chicago. 

'84. Chas. B. Horrell, Colchester, 111. 

'84. Wm. Thos. Bellamy, Pleasant View, 111. 

'84. J. S. Inks, Nappanee, Ind. 

'84. M. Mikkelsen, Wells, Minn. 

'84. I. H. Reiley, 168 W. 23d St., New York City. 

'85. James B. Eagleson, 512 Burke Building, Seattle, Wash., 
writes: "I have arrived home after a pleasant trip East. Am 
glad to see the Alumni Association being worked up, for it will 
be of much benefit to the school as well as to ourselves." 



114 THE PLEXUS, * 

'85. M. L. Winstead, Wetaug, 111., writes that he is doing 
well. His best wishes are for the success of the P. and S. and 
the alumni wherever they may be. 

'86. Wm. M. Beach, Shelton, Wash. 

'86. J. R. Williams, White Pigeon, Mich., would like to hear 
of Vincent E. Duff, "86. 

"86. S. A. Ellis, Azuza, Cal. 

'86. H. E. Creppin, San Diego, Cal. 

'86. T. E. Taggert, Bakersfield, Cal. 

'86. F. E. Gallison, Coultersville, Cal. 

'87. N. M. Voiding, Des Moines, Iowa, Professor of Neur- 
ology in the Iowa College of Physicians and Surgeons, says: 
"I hope to be able to attend the meetings in the future." 

'87. G. J. Kaumheimer, 508 3d St., Milwaukee, Wis. 

'87. C. F. W. Kordenat, Reedsburg, Wis. 

"87. C. M. Oviatt, Oshkosh, Wis. 

'87. F. A. Hanson, Abrams, Wis. 

*87. A. Schneider, 2421 Dearborn, St , Chicago, contributes 
a letter appearing elsewhere in this issue. 

'87. W. Z. Flower, Gibbon, Minn. 

1895. Dr. A. A. Lowenthal was married to Miss Clara Dyer 
June 27, 1899, at Hospital, 111. The Doctor's address is 3707 Prai- 
rie Avenue, Chicago. 

1H95. Dr. John M. Mayhew was married to Miss Busbey on 
June 5, 1899. 

1896. Dr. Thomas Clay Hollister was married to Miss Mabel 
McLaren June 21, 1899, at Louisville, Neb. 

You will notice a list of assistant secretaries. The secretary 
has appointed these entirely without authority, but he hopes in 
this way to get .some facts as to every graduate. If the assistant 
secretary will write accepting the assignment, the secretary will 
furnish him the best address obtainable for each of the graduates 
of his year. 

'83. M. R. Weidner, Dolton, HI. 

'84. A. H. Brumback, 100 State St., Chicago. 

'H'). G. E. Brinkerhoff, Oakland, Cal. 

86. W. C. Abaly, Madison, Wis. 

'87. N. M. Voiding, Des Moines, Iowa. 

'88. F. C. E; Matti.son, San Diego, Cal. 

'89. A. S. Gray, 103 State St., Chicago. 

'90. Edward Doepp; Blue Island, 111. 



Alumni Notes. Il5 

•91. E. E. Maxey, Caldwell, Idaho. 

"92. Edgar Reed Hawley, Monroe and Dearborn Sts. , Chicago. 

•93. Chas. Stoltz, South Bend, Ind. 

•94. E. A. Planck, Union, Mich. 

'97). P. P. Seville, Monroe and HarrisonSts., Chicago. 

■97. Cha-s. W. Carter, Aledo, 111. 

'98. James M. Neff, Cook County Hospital. 

"99. H. C. Heald, Millard, Nebraska. 



LIBRARY NOTES. 

We are indebted to Dr. Geo. P. Butler for a substantial gift 
of several hundred journals, which are helping out in the task of 
completing our files. 

The following articles from members of the faculty have been 
noted in the journals: 

Dr. W. L. Ballenger, "Case of Chronic Mastoiditis — Radical 
Operation and Closure of the External Wound by First Inten- 
tion."" Chic. Med. Recorder, May, 1899, p. 393. 

Dr. W. A. Evans, "Tuberculosis in Monkeys."" Chic. Clinic, 
June. 1899, p. 227. 

Dr. Bayard Holmes, "Cerebro-s[)inal Pneumococcus Infec- 
tion. Report of Case. Jour. A. M. A., June 17, 1899, p. 1360. 

Dr. Casey A. Wood, "Chairman"s Aidress at A. M. A., of 
the Ophthalmic Section."" Jour. A. M. A., July 1, 1899, p. 1. 



Il6 .' I'HE PLEXtl^. 

WHY HE didn't ENTER THE PROFESSION. 

Prom a boy he had intended to take up the study of 
medicine, so upon reaching the age when he was called 
''young man" by his elders, he journeyed to the great city 
wherein was located the medical college of his choice. 

How proudly he felt when he thought that at last the 
dream of his youth was to be realized! What happiness in 
building visions of large fees for professional consultation! 
And then the dignity of the word "Doctor!" It all seemed too 
good to be true. 

In those days — some thirty years ago — ^it was not neces- 
sary to have the extensive jjreliminary training which is re- 
quired now to enter a medical school. This young man had 
scarcely passed the "little red school house" stage, yet he was 
applying at the door of the leading medical college of his na- 
tive state. He felt no timidity — nothing could thwart him in 
his purpose. He was ushered into the presence of the presi- 
flent of the college — a stern and dignified old gentleman, 
whose greeting nearly resembled a grunt. 

"Well," said he, after explainations had been made, "so 
you want to fit yourself for the medical profession. What's 
your namey" 

" Killmore, sir — John Wes " 

"What," roared the professor. "What's that'? Want to 
learn to cure people with that name'? Killmore, no indeed. 
You go back home, young man, and think it over. Don't ever 
think of practicing medicine unless you change your name." 

And thus the dreams of youth were dispelled. All 
thoughts of a career in the medical profession were forever 
forgotten. The young man "drifted'' for a few years, as is 
the usual custom of young men who are disappointed in love 
or business, and afterward. settled down in the merchant tail- 
oring business in Chicago. 

Mr. Kilmore is successful, and feels that he has been com- 
pensated for being forced to give up his chosen profession on 
account of an inappropriate name. 




DANIEL A. K. STEELE, M. D. 

Actuary and Professor of Principles and Practice i of Surgery and 

Clinical Surgery in the College of Physicians and Surgeons. 



THE PLEXUS 

THE OFFICIAL ORGAN OP 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 

UNIVERSITY OF ILLINOIS, 

^"OL. V. AUGUST 20th, 1899. NO. 4. 



AN OPEN LETTER. 

By Dr. D. A. K. Steel. 

Berne, Switzerland, July 25, 1899. 
-Editors "The Plexus": 

It has been my good fortune to combine a most delightful 
summer vacation with opportunities to study the technique and 
personalities and to compare the work and methods of some of 
the most famous surgeons in the world, and it has occurred to 
m.e that perhaps a letter to the Plexus might prove interesting 
reading to my former P. and S. students. It was my good luck 
the day before I sailed on the "Camj)ania," while in New York, 
June 16th, to visit the Roosevelt Hospital and attend a clinic by 
Dr. Robert Abbe, in the Syms operating theatre, which, by the 
way, is one of the handsomest and best appointed operating 
rooms I have ever seen. The entire walls, ceiling and doors are 
white Italian marble, the floor mosaic, the seats slate and iron 
and so arranged as to be thoroughly flushed, shelves and basins 
of heavy glass. The whole room aod all its fittings conforming 
admirably to modern ideas of aseptic surgery. Dr. Abbe, his as- 
sistants and nurses all wear rubber gloves during the operations 
in addition to the usual surgical gowns. The same scrupulous 
care in regard to the preparation of the patient, the hands, and 
of the instruments, that has so long been in vogue at the P. & S. 
is observed here. 

Case I, brought before the clinic by Dr. Abbe for operation, 
presented the following history: Man, aged 40, weight, 220 lbs, 



114 THE PLEXUS. 

powerful physique, gripman by occupation, and always enjoyed 
good health until about six months previously, when on his car 
felt a sudden attack of dizziness come on when he had presence 
of mind enough to stop his car before temporary unconsciousness- 
supervened. He resumed work after a few days, but suffered 
from a- second attack in all respects similar to the first some 
weeks later. After the second attack he developed Jacksonian. 
ei^ilepsy in the right arm and has had several characteristic seiz- 
ures during the last few weeks. A diagnosis of tumor in the left 
motor area involving the arm center was made and Dr. Abbe 
made an osteoplastic resection of the left tempora-parietal region 
over the motor area by means of a narrow chisel, then when the 
horseshoe-shaped channel had been cut througla the bone flap it 
was reflected and the dura exposed; careful palpation did not re- 
veal any evidence of a difference in density of the brain structure 
nor did the surface present any abnormal appearance; the dura 
was now carefully incised but no pathological changes noted; the 
exploring needle was then thrust in various directions, but no 
unusual resistance was felt to its advance through the cerebral 
tissue, and, after conference with his associates, Dr. Abbe deci- 
ded there was no tumor present, and closed the dura with fine 
catgut suture, placed a small folded rubber tissue drain under 
the edge of the bone flap, and sutured the scalp wound with 
buried catgut sutures. The entire operation was perfect in tec- 
nique and surgically was ideal, but pathologically it was a dismal 
failure, and from a diagnostic standpoint its results were nega- 
tive, and its effect upon the patient is problematical. 

Case II, was an operation on a delicate young man for re- 
current appendicitis. He had suffered for more than a year fi^om 
frequent attacks of indigestion, abdominal pain and gradual ema- 
ciation with loss of health and strength. The pain had become 
more localized at McBurney's j^oint, and operative intervention 
was sought. Dr. Abbe made a very short incision, drew oub the 
caecum and a very long and chronically inflamed appendix with a. 
clubbed extremity, placed a gauze sponge around it and encircled 
its base with a jouckering string catgut ligature, cut it off and 
buried the stump with another circular pursestring ligature 
placed around the first one about one- fourth of an inch equidis- 
tant. No drainage was used, and the peritoneum, muscular 
structure (which had been merel separated) and the skin were all 
sutured separately with fine buried catgut sutures. The whole 



An Ox>en Letter. — Steele. 115 

operation was a beautiful demonstration of tiie skill, simplicity 
and rapidity of a master surgeon. 

Case III, was a colored woman, very much emaciated, upon 
whom he operated for tubercular peritonitis. A medium incision 
was made and after the escape of a large quantity of ascitic fluid, 
the abdominal cavity was thoroughly flushed with several gallons 
of a normal salt solution, then well mopped out, and finally the 
entire serous surface, which was studded with tubercles, was 
swabbed with a solution of naphthalin-camphor. The omentum 
was greatly thickened and folded upon itself. Abbe reported 
excellent results from this method of treatment and cited several 
illustrative cases from his clinical experience. 



July 5th I had an invitation from Mr. Victor Horsley to wit- 
ness an operation at the University College Hospital, London, 
for the extirpation of a Gasserian ganglion for tic doulereux. 
The patient was an old man of 68 years, who had suffered from 
an excruciating facial neuralgia that had resisted all medical 
treatment for the past two years. Mr. Horsley did a Krause op- 
eration reflecting the usual horseshoe- shaped flap of the soft 
parts over the temporal region 'of right side, and then made a 
large trephine opening through the skull and with a large cutting 
bone forceps rajjidly enlarged the trephine opening until it was 
about three and one-half inches in diameter, when he raised up 
the brain by means of a large, flexible retractor, pushed the mid- 
dle meningeal artery forwards slightly and tamponed all around 
with many small pledgets of cotton, when he carefully incised 
the dura close to the root of the nerve parallel with the course of 
the middle meningeal artery, and with great exactness dissected 
out the ganglion of Gasser without any special difficulty, although 
there was slight but persistent oozing of blood from a torn vessel 
at the base of the brain after its removal which was controlled 
by tampons frequently replaced. The pieces of bone removed 
were not replaced; a gauze drain was placed in lower angle of 
the wound, the flap sutured in place with horse-hair and a volu- 
minous gauze dressing applied to the wound. Horsley impresses 
one by his exact anatomical knowledge, his deliberation and cool- 
ness, and his gracious manner. 



July 12th, at Bonn, I renewed acquaintance with Prof- 



1 16 THE PLEXUS. 

Schede, formerly of Hamburg, but for the past four years in the 
University of Bonn, operating in the Johannis Hospital. 

Case I, that this genial and talented surgeon showed me, 
was a man of 30 years suffering from a septic thrombo- phlebitis 
of the jugular and lateral sinus. He operated by ligating and re- 
secting the internal jugular and trephining the temporal region, 
and z'emoving a septic thrombus of large size from the sinus, tam- 
poning the wound with gauze and draining. The next day the 
patient was in excellent condition; temperature greatly reduced, 
pulse better and mind much clearer. He bids fair to make a good 
recovery from what, without operation, is an inevitably fatal dis- 
ease. Prof. Schede claims excellent results in septic meningitis 
by trephining, and has reported four or five recoveries. 

Case II, was a modified Kraske operation for carcinoma of 
the rectum in a woman of 50 years. The result seemed quite 
satisfactory. 

Case III, was a very interesting one of plastic surgery, in a 
boy of 14 whose right cheek and lips had been destroyed by a 
noma. The cheek and upper lip were restored by means of a 
flap taken from and including nearly all of the forehead. The 
lower lip and chin was re-formed by a flap from the left cheek 
and side of the neck. The operative defects were supplied with 
Thierch grafts from the boy's thigh. While his appearance was 
somewhat improved, he would never take a prize in a beauty 
show. Prof Schede had a class of between forty and fifty senior 
medical students in attendance this semester, and as each patient 
was brought in he would invite down two members of the class 
and direct his explanation of the pathological conditions and op- 
erative indications especially to them in a somewhat colloquial 
style. 



From Bonn I went direct to Prieberg, where (July Mth) I 
made the acquaintance of Prof. Kraske, and had the pleasure of 
witnessing several fine operations at the "University Chisurgical 
Klinek." Prof. Kraske, in his personality, reminds me very 
much of our Prof. Murphy, who, by the way, is very well 
known throughout Germany. He also calls down the students 
and catechises them vigorously on each new case — and directs his 
clinical lecture to one or two students. He has about seventy 
students on his roll-call, and what impressed me as singular was 
that as soon as he got through with his quiz and the presentation 



An Open Lettei — Steele. H' 

of new cases, and began important operations, the amphitheatre 
was quickly deserted, sometimes not more than a dozen students 
remaining to witness the operations. I met several American 
students here and had the pleasure of meeting our Prof. Good- 
kind and Dr. Snydacker, who were doing some special 
work. 

Case I, presented a somewhat interesting history. Young 
man of 19, met with slight injury to his head, causing a scalp 
wound ten years ago, but giving rise to no after symptoms. Three 
years ago he had a small melanotic sarcoma removed from the 
instep of his left foot. Two years later a small secondary tumor 
of the same character was excised from his left breast, and at 
present there is a minute nodule near the site of the second ope- 
ration cicatrix. About three months ago he develojied Jackson- 
ian epilepsy in his right leg and was brought to Prof. Kraske 
who declined to operate, as he believed that the local spasms 
were due to the formation of a recidative sarcoma in the leg 
-canter of left side of brain, similar in character to the other 
tumors from which the boy had been af&icted for the past three 
years. His parents took him home, but as the seizures were be- 
coming'^more frequent and severe they brought him back to the 
hospital and insisted upon at least an exploratory operation to 
determine the character of the tumor. Kraske consented. The 
boy smilingly walked into the clinic and was shaved and jDrepared 
in the presence of the class. After demonstrating the location 
■of the leg center by means of a chart and a hardened brain, he 
applied a cystometer to the boy's head and located the fissures of 
Sylvian and Rolando and then made aV-shaped osteo- plastic resec- 
tion of the skull over the left side of the head overlying the motor 
area. He used a chisel, an electric revolving drill and a wire saw in 
cutting through the bone; upon reflecting the bone-flap the dura 
was at once seen to be opalescent, thickened and adherent to the 
brain over an area of two inches in diameter. The dura was in- 
cised and carefully detached from the brain, when a yellowish 
looking tumor about the size of a pullet's egg was disclosed, occu- 
pying the leg center and formed in the brain tissue. Upon being 
incised it presented the apjDearance of a granulomata and proved 
to be a localized cerebral tuberculosis, which was removed by a 
curette, the wound packed with iodoform gauze and the bone-flap 
replaced. Kraske remarked that he had correctly located the 
-tumor, but was mistaken in regard to its character. I do not 



118 THE PLEXUS. 

know the subsequent history of this case, but undoubtedly im- 
provement followed. 

Case II, was a boy of 14, brought in after a street accident,, 
suffering from a fracture of the base of the skull and the right 
clavicle: blood was oozing from the right ear and subconjunctiva 
chemosis was marked. His head was thoroughly cleaned, the ear 
dried out, and the case treated tentatively, without any operation. 
Next day marked cellular emphysema extending from the site of 
the fractured clavicle down the right side supervened, his menial 
condition was much improved, and when I left Prieberg he was 
said to be convalescing. 

Case III, was a very extensive carcinoma of the rectum, in 
an old man of 67, quite emaciated from two years suffering. In 
this case Kraske made his modified operation for cancer of the 
rectum. First, through a long, oblique abdominal incision, liga- 
ting the messentery and securing the haBmorrhoidal vessels and 
loosening the sigmoid and rectum freely from their cellular bed, 
after shutting off the general cavity of the abdomen by many 
strips of gauze, he turns the jDatient on the side and makes the 
usual sacral incision down the sphincter ani, frees the rectum be- 
hind and easily i:)ulls down the infected portion into the wound,, 
and while an assistant holds the bowel he divides it above the 
cancer and then turns the diseased part downwards and divides 
the gut again between the sphincter and diseased area and rapidly 
sutures with silk and catgut, packing this wound also with gauze. 
One of his iDeculiarities is to leave all wounds open and allow 
them to close by granulations. He avoids peritonitis and infec 
tion, but gets numerous ventral hernias. 



From Frieburg I came directly to the beautiful Swiss town 
of Berne where I have settled down for a good rest. I spend the 
mornings, however, with Prof. Kocher, at the ' Inselspital,"" 
where I have seen many goitre, hernia, and plastic operations of 
great interest, by this celebrated surgeon, but I have already 
spun this letter out too long to detail any more cases. My ob- 
servation of American, English, German and Swiss surgeons- 
during my vacation this summer leads me to the conclusion that 
an ideal surgeon is a composite made up of American tecnique,, 
operative skill and ingenuity; English diagnostic ability, con- 
servatism and regard for the rights of the patient; German path- 
ological knowledge and surgical daring, with Swiss nonchalence. 
The more I have seen of foreign surgery, the more I am con- 
vinced that American surgeons are the equals of any. The more 
I see of foreign medical teaching, the more I am convinced that 
the P. & S. is quite up to the times in everything except wealth 
of clinical material. We need a large hospital under the control 
of the faculty and we must have it. 

D. A. K. Steele, 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 
UNIVERSITY OF ILLINOIS. 

Editor, H. J. STEGEMANN, '02. Business Mgr. G. G. DOWDALL, '00. 

Class Editors: 

F. C. BLACKWELDiER.'OO. W. O. McDOWELL, '01. J. M. MEYERS, 02 



Faculty Department, Dr. W. A. Pusey. Athletics, 

Alumni, Cliutcal Department, E. a. Gansel 

Publishers, ----- DOWDALL & STEGEMANN. 

Subscription $1.00 per Annum in advance. Single copies, ,15 cents. Issued Monthly 
Send all remittances and communications as to subscriptions and advertising to G. Q. 
DOWDALL, Business Manager, 813 W. Harrison St. 

Entered at Chicago Post Office as Second-Class Matter. 

Any subscriber desiring the Journal discontinued at the expiration of his subscription 
should so notify the Publishers; otherwise it will be assumed thai the subscription is to be 
continued and the .Journal sent accordingly. • 

Contributions of matter suitable for publication are invited, and should be sent in not 
later than the 25th of the month previous to that of publication. The publishers wiUnot liold 
themselves responsible for the safe return of MSS. unless sufficient stamps are forwarded 

EDITORIAL. 

Kindly look at the address on the wrapper enclosing the 
journal and note if your name and address are spelled correctly. 
If they are not, kindly drop us a line that we may make the 
changes necessary to have them correct. 

* -X- 

We have received during the past month many flattering let- 
ters about the outward appearance of the Plexus and the 
quantity and quality of the reading matter on the inside. 

The outward appearance is all that we accept credit for. It 
is to those who take interest enough in the school to furnish us 
with the valuable contributions, that the thanks are due for the 
reading matter. 

We are glad to know, however, that the Plexus is so well 
thought of by so many of the alumni, and we take this opjDortu- 
nity to thank those who have been kind enough to encourage us 



120 



Editorial. 



in our efforts to make this the best medical school journal 
published. 

We hope to be able to continue improving the journal, and, 
with the support of the alumni, both financially and in contribu- 
tions of interesting reading matter, as well as contributions from 
the faculty, -we "will do so. 

Therefore, if you, in course of time, get a bill for subscrip- 
tion, or meet wdth something entertaining or instructive, please 
remember that we can use all the money due us for subscriptions 
and wall be pleased to haA'e you send us an account of anything 
that will be of interest to the alumni or medical profession, to be 
published in the Plexus. 



As a result of the recent examination of candidates for license 
to practice medicine in Pennsylvania, the State Board of Exami- 
ners has granted certificates to 375 out of a total of 41'5 who pre- 
sented themselves. This was the largest number ever before the 
Board at one meeting. 

Among this number were these P. & S. graduates of the 
class of '99: — Strohesker, Chambers and Hillard — and the records 
made by them before the Examining Board proves clearly that 
P. & S. doctors are "Good Doctors." 

The record is as follows : 

Strohecker. Chambers. Hillard. 
Per cent. Per cent. Per cent. 



Anatomy 

P. Pathology 

Diagnosis and Hygeue 

Surgery 

Obstetrics 

Chemistry 

Therapeutics and P. . . 

* 

General Average. 



90 

83 
82 
96.5 

82 

82.5 

75 



84.43 



97 

80.5 
90 
100 
91 
80 



87.21 



93 

84 
75 
92.5 

80 
77 
68 



81 . 36 



Doctor James B. Eagleson, of the class of '85, whose picture 
and biography appear elsewhere in this issue, contributes a very 
interesting case of "Large Uterine Fibroid," accompanied by 
pregnancy. Any one who reads the doctor's biography carefully 
will readily see that he has not been content to remain at the 
bottom of the ladder of "fame," but has forged ahead, and we 



THE PLEXUS. 121 

learn from o^ood authority that he stands at the head of the list 
of western surgeons, though he is too modest to admit of that 
fact in his biography. The doctor visited his alma mater this 
spring and attended the annual meeting of the Alumni Association. 



•X- 



Not only is Doctor Steele an exceptionally good surgeon, but 
he is also quite a poet, as the following few lines will attest, and 
which were written on a "Postkarte" on board the steamship 
"Borussia," and addressed to Miss Heelan : 

Rhein-Dampfschiffahrt 
Kolnische und Diisseldorfer Gesellschaft 



An Bord des Dampfers: ,, Borussia'' 

den July 12, 1899. 
Dear Elizabeth Marie : 

Don't you see, we are having a time, on the Rhine. Just 
lovely recreation — and a vacation — not a lecture — or a fracture- 
just eating and sleeping— and drinking and peeking — having fun 
on the run— and writing a card to old pard — so she will know 
where we go — far away from Chicago — and old P. & S. — well, I 
guess! — eh, Bess? 

D. A. K. Steele. 

We also have the pleasure of printing a very enterainino- let- 
ter from the doctor, addressed to the Plexus, in which he gives 
in an unusually clear and interesting manner, various clinical 
cases witnessed by him while on his travels through England, 
Germany, Switzerland, etc. 

It is quite in evidence that Dr. Steele thinks that P. & S. is 
up among the leaders as a medical school, and he has every reason 
ttl think so, from the excellent records being made by the alumni 

of this school. 

* * 
* 

The announcement comes from across the water of the wonder- 
ful discovery by Doctor Remond French, ' 'The Making of Brains 
by Electricity." 'Tis said that, by a series of electric shocks, 
the brain can be made to absorb knowledge as a sponge absorbs 
water, 

Do you get the full import of this most important discovery? 
Do you realize the changes that will be brought about by the ap- 
plication of this intellect maker? 

A few vigorous applications of the current and see the re- 



122 Editorial. 

suits — a sluggish and dull brain is aroused and a brightness 
given to it that is equaled only by the brightness given to a tin 
dish pan by a sapolio advertisement; a bank president on trial 
for defrauding depositors is given an application just before 
testifying, and, behold ! — he remembers everything; a rich man, 
up before the Board of Review, will be taken to a private room 
and the machine will be applied to his tired brain, when lo! — 
he will schedule property that he would have forgotten had he 
not had the benefit of this wonderful discovery. 

Then, too, it can be applied with equal success to both sexes 
— a husband will be made to think of the errands to be performed 
and the letters in his pocket to be mailed, etc. ; a wife be made 
to remember the holes in her husband's socks, that need darning, 
and the buttons off his shirt, etc. 

What a boon it will be to intelligence offices; how every em- 
ployer will hail this brain maker with joy. Clerks, book-keepers 
servants, fools, idiots and possibly believers in "divine healing," 
will be benefitted; and last of all, what a help it will be to the 
overworked medical student w^ho, when preparing for a written 
quiz; will not be compelled to sit up half the night preparing his 
pony, instead, all that will be necessary is to apply the machine 
to his throbbing temple and the answers to the questions will be 
given so clearly and concisely that a professor will be led to think 
he is an unusually bright student and mark his paper 100. 

It is to be hoped that the machine will be manufactured in 
such a compact form that one may constantly have it about ones 
person, ready for instant use at all times. 

By the free use of the Brain Making Machine, Grape Nuts, 
and the wonderful Goat Remedy of Doctor Roberts, which wards 
off old age, there is no reason w^hy future generations will not be 
as wise and live as long as the ancient philosophers of which his- 
tory tells us. 

* 
* * 

The recent death of Mrs. Flanders after a week or more of 
"divine healing'' goes to show that the fools are not all dead yet. 

Just give them time however and they soon will be, for under 
the administration of "divine healing" they "pass on" in rapid 
succession or — as we ordinary mortals call it, "die". 

So many cases of the "divine healing" art have proven disas- 
trous to the patient receiving .such administration that it is high 
tiftie some legal action should be taken in the matter, that those 



IHE FLEXiTS. 123 

Tvho are not religious fanatics or religious impostors may be pro- 
tected and their life saved. 

The Chicago Tribune, of July 30th, very concisely sums up 
Ihetrue status in the following words: "Religious fanatics or re- 
ligious impostors of the Dowie type will be with us always and 
will continue to have followers and dupes. The law will not in- 
terfere to protect the latter. If they choose voluntarily to die 
without medicine, rather than live with it, they will be allowed 
to die. The cranks or charlatans who told them falsely that 
mental or spiritual means would save their lives will not be pun- 
ished. Adult fools will be left to their foolishness so long as 
they are the only sufferers. 

But there is another aspect to the question. Suppose the 
person sick is a child and not an adult. Suppose the parents of 
that child, having no faith in medicine, call in one "divine healer" 
or all the healers of Zion's House and yet the child dies. Suppose 
the physicians agree that the child would have lived had it been 
given medical care. Then unquestionably a case will present it- 
self that the State's Attorney can take hold of. Adult cranks 
may be permitted to kill themselves. They cannot be allowed to 
kill others and then plead as a defense that 'God hates medicine'." 

One scarcely picks up a paper now days without one or more 
cases, such as the Flanders case, being recorded though few of 
the administers of "divine healing" go to the extreme that Mrs. 
Bratz, who attended Mrs. Flanders, did and show in such unmis- 
takeable terms what fools or impostors the "divine healers'"really 
are. It is scarcely conceivable that, at the end of this enlighten- 
ed century, any one that had a grain of common sense would be- 
lieve such rot as the reason why Mrs. Flanders was not saved. 
The reason given is that — "Her husband was not a believer in 
divine healing. If he had believed as his wife did she would have 
lived. God was angry because he made fun of the faith. When he 
said he was going to call in a doctor I nearly cried, because I knew 
she would die then. God hates medicine. He wants us to have 
faith in his divine healing. I'm sorry Mrs. Flanders died, because 
she had faith, and her husband, by making fun of the faith, took 
her away from him. When Mr. Flanders said he did not have 
faith I saw that we needed more prayers, and so I called our elder 
frcm the Zion Home, D. C. Holmes, and we two prayed together.' 
Had such reason been given two or three centuries ago to the 
uperstitious tribes of uncivilized and uneducated inhabitants of 



121 Editorial. 

an unexplored country one would then have expected that some 
could be found to believe it. Owing to their superstitiousness, 
however, they might have been persuaded that the"divine healer'' 
(?) instead of being possessed of the "Spirit of God" was possessed 
of the Devil and decided the good of the community required that 
she "pass on' and forthwith carry out such a decision. 

Every thinking person knows that a penalty is exacted for 
every "law of Nature" that is violated and all the prayers in 
Christendom will not Gxemj^t any one from paying the penalty 
nor will they bring back to health and happiness one who, know- 
ingly or unknowingly, has violated such laws. 

Stringent laws should be made that fools and impostors that 
advocate the "divine healing"' method will be brought to task 
and made to suffer for their wantoness. 

Doctor Nelson W. Wilson in an article entitled "Christian 
Science Methods'' published in the August number of the Buffalo 
Medical Journal shows up Christian Science (?) in its true light. 
The time is at hand when "divine healers" who obtain money 
under false pretense should be placed in the category to which 
they belong and the public protected from such impostors who 
trifle with "Life and Death". 



THE HIGH AIMS OF THE PHYSICIAN. 

The above title was the topic considered by Beverly Robinson 
M. D. in the Presidential Address delivered before the American 
Climatologicol Association, May 9th, "99, and published in the 
New York Medical Journal under date of August 12th, 1H99. 

While directly concerning the medical practitioner there is 
meat therein for all other classes of workers in the universe, ir- 
espective of the station in life that is occupied by them, and, if 
the iwincipals and morals to be found in this address could be in- 
stilled into men, the change so earnestly desired by the Doctor 
and his worthy fellows would soon be a realization instead of a vain 
hope. 

How many of us when we read the following words of the 
Doctor, can call to mind just such a character as depicted in the 
picture presented to our minds by those words. 

The Doctor says, — "In latter days some men seem to love 
money too much. They appear to fall from their high estate in 
their contest for it. Not content with an honorable sufficiency, 
they want more wealth, and why? Is it to increase the sum of 
prosperity and happiness among those less favored than them, 
selves y Is it to endow colleges, to promote learning, to amelior- 
ate and lessen the burdens of the poor and downtrodden? Not 
always, I regret very much to say. They want money for money's 
sake and that alone. Given every thing almost that makes their 
lives honored and respected, they act as if the mere acquisition 
of lucre were their ultimate worldy desire." 

Have you not before you a mental picture of just such a man? 

Doctor Robinson says however, ^ — "Don't mistake me I These 
are the few, the very few, and yet they hurt us; they hurt the 
noble ends we would all most gladly serve.'" 

"Tis true; the few do hurt us. The time once was when a 
man, to be honored, loved and respected by his fellow men, and 
looked upon as a model for the younger generation to be guided 
by, had to have all those qualities that would make him a superior 
character. Today it seems that the conditions have changed very 
materially. Fifty years ago men were judged by their characters, 
their kind acts to their fellow men, their devotion to their home 



126 THE PLEXUS 

and all that was sacred therein, their considerations for the hap- 
piness and well-far^ of the less fortunate brother. There were 
few millionaires then. Look at the state of affairs today. Is not 
the younger generation being taught daily, not by words neces- 
sarily, but by actions, that the high aim of life is the acquiring of 
a fortune ? 

The slianing lights, the models placed before us, are usually 
the ultra-millionaires, whose w^hole lives, in most instances have 
been just the reverse of the models of the past. 

What material benefit can the world be said to have gained, 
even though such a man with the wealth of a "Creosus", in his 
declining years, gives thousands to this, that and the other, when 
tis known that all those years that were spent in acquiring his 
vast fortune, he mercilessly trod under foot and made mere slaves, 
those who were so unfortunate as to be in his emi^loy. ? 

That he might treasure up a few more hundred thousand dol- 
lars, how often has he not taken the very "bread of life" from 
the poor.wive§ and babes of the unfortunate beings in his power, 
by a corner in the market or a cut in the already scant wages? 
Thousands are made to suffer that one may roll in wealth, and 
possibly, in after years to atone for the sins committed by him, 
to give up some of his ill gotten wealth that the world may stand 
up and point to him as a liberal and kind man to his fellow beings. 
How much better would it have been in him, had he at the 
time he was accumulating his vast wealth, given a gener- 
ous thought to those who were assisting him to attain the position 
held by him and made their lives more worth the living, by im- 
proving their conditions and surroundings as he was improving 
his O'^^n. 

Then instead of its being merely said of him: He is a suc- 
cessful man. he's wealthy beyond all dreams; and that put before 
all other things as a requisite for a successful life, it might have 
been said of him; He loved his fellow men, and to prove that love 
he lifted them out of their lowly life into a sphere of health and 
happiness, and the world was made better for his having lived in it. 
To quote Dr. Robinson's words "For the physician as for 
other men, the noblest aim of his ambition should be to establish 
character.'' 

Quoting from the oration, by Duckworth, Dr. Robinson clear- 
ly shows what the High Aims of the Physician should be.— Duck- 
worth said: "We are i^erhaj^s too much disposed to commemor- 



High Aims of a Physician^ 1£7 

ate the scientific achievements of our great men, but let us not Be 
unmindful of their characters. We know that genius is not al. 
ways coincident with the highest moral or spiritual perfection, 
but when both these qualities are graciously combined in any one, 
we feel that we are in the presence of a truly great man, of one 
who becomes a personage and a power for good in his day and 
generation. In such a prosession as ours we can never afford to 
lose sight of the preponderating influence of character in all who 
join our ranks and have to minister to every grade of our com- 
mon humanity." 

Continuing Dr. Robinson states in his own words, the 
following : 

"Some men, perhaps, in what I have tried to outline, may find 
things to criticise or take exception to; they may say all this is 
very well, but is it not Utopian, impractical, impossible"? I pre- 
-sume this is true, but it is equally true of all idealism, of all per- 
fection. And yet what we very much need to-day in our lives is 
this very idealism. We have enough and more than enough of 
the practical. Our daily routine is eminently practical. Most of 
us are obliged to work, to labor, to save. We know that in this way, 
and this way alone for the majority of men, success is ultimately 
reached. Ignorance and deception and false ideas of life and its 
purpose surround us. Worldly applause, the desire to have fame 
at any price, and even though it be acquired by means that are 
unworthy; the constant, ceaseless endeavor to outstrip one's fel- 
lows and get ahead, may capture those who are filled with a nar- 
row, selfish ambition. But is such a struggle to be imitated or 
admired? Is the reputation thus acquired ever enduring? lam 
sure it is not. The men whose fame is perennial, whose deeds 
praised and glorified after they have gone and disappeared from 
sight, are those whose memories give us always a thrill of en- 
thuvsiasm which awakens what is best within us, and tells us of a 
goal to win that does not pass away and is not purely chimexf- 
<!al." 



LARGE UTERINE FIBROID ACCOMPANIED BY 
PREGNANCY. 

Reported by James B. Eagleson M. D. Seattle Wash. 

The following case is reported on account of several interest- 
ing points which it presents, both clinical and pathological. 

Mrs. G. S., aged 42 years, was admitted to the Seattle Gen- 
eral Hospital January 13th, 1899, and gave the following history.. 
There was nothing out of the ordinary in her pre-menstrual his- 
tory, and she had always enjoyed excellent health up to the birth 
of her daughter, now sixteen years old, after which no other 
pregnancy occurred. A few years after the childbirth her men- 
strual flow began to be more profuse than was normal with her, 
and gradually increased until two years ago, when it became quite 
excessive and began to affect her general health. About this time 
she also noticed an enlargement over the womb which led her to 
consult a physician regarding her condition. He pronounced it a 
fibroid tumor of the womb, and advised her to let it alone, unless 
it should cause her more trouble by increasing in size or increased 
menorrhagia. He evidently thought that at her age there was 
some hope for an early menopause which might check the devel- 
opment of the tumor. 

Its grow^th continued to be slow and gradual and it gave her 
little inconvenience aside from the general debilitated condition, 
until about three months before coming to the hospital, when it 
began to increase in size quite rapidly and was at times very- 
painful. The menstrual flow had gradually diminished for 
sevei-al months, and for the past three, had ceased entirely, this 
was taken to be the approaching menopause. During these three 
months her general health had declined very rapidly. For three 
.weeks before leaving home she noticed a slight afternoon rise of 
temperature but at no time did she experience any rigors. which 
might indicate the formation of pus. 

On physical examination she was found to be quite weak and 
emaciated. There w^as an abdominal tumor present which in- 
creased her size to that of a seven months pregnancy. Palpa- 
tion revealed it to be a very firm and elastic tumor, (most prob- 
ably a solid growth) very nodular and irregular in outline, and 
much more prominent on the right side where it extendedup- 




JAMES B. EAGLESON, M. D. 



Large Uterine FlJnolil — A'>i(jlison. 129 

ward and outward above the crest of the ilium. There was also 
quite a large nodule in the median line and a little to the left of 
it, above the body of the uterus which was frnely movable and 
was evidently attached to it by a long pedicle. The tumor was 
very tender to the touch over its whole area but especially on the 
right side, which was the seat of the severe pain that she suffer- 
ed at times. On vaginal and rectal examination the tumor aj)- 
peared to fill the upper part ^f the pelvic cavity and by its press- 
ure caused considerable interference with the no]*mal action of 
-both bladder and rectum. 




The diagnosis arrived at was that of a large multiple uterine 
fibroid with localized peritonitis. It was decided to remove it by 
an abdominal hysterectomy, which operation was performed Jan- 
uary 19th. 



130 THE PLEXUS. 

The patient came from the operating table in a very weak 
condition from which she did not rally and died at the end of 
forty eight hours, apparently from exhaustion and general weak- 
ness, hastened by the shock of the operation. 




On opening the abdominal cavity we found that the uterus^ 
together with the mass of fibroids involving it, had made almost 
a complete half turn to the right on the axis of the uterine canal. 
The largs mass on the right side which projected up under the 
margin of the liver was a large cylindrical shaped fibroid growing 
from the anterior wall of the uterus, and as it increased in size, 
had gradually forced its way into this position for want of room 
to grow in any other direction. The torsion thus produced had 
brought the left ovary and tube over to the right side of the 
median line, and the right one had been forced around behind the 



Large Uterine Fihroid — Eaglesoti. 131 

uterus to the left side. It had become cystic, forming one large 
cyst the size of an orange, and was filled with broken down blood 
from an old hsemorrhage into it. It was this ovarian cyst which 
was felt on palpation through the abdominal wall as a peduncu- 
lated nodule above the uterus. The broad and long ligaments 
were much elongated as a result of the torsion, so that it was very 
easy to ligate them with their accompanying vessels. 
The cyst of the right ovary was accidentally^ ruptured during its 
removal and was found to be full of the remains of an old blood 
clot resulting from a haemorrhage into the cyst cavity.. 




The outer end of the large nodule on the anterior uterine 
wall was quite soft and an incision into it revealed a cavity con- 
taining broken down tissue and pus. This abscess formation no 



132 THE PLEXUS. 

doubt accounted for the elevation in temperature for some time 
before the operation. 

When the uterine cavity was opened by an incision through 
the fundus we wei'e very much surprised to find that it contained 
an emaciated fcetus of about four months development. Prior to 
this time pregnancy had not been suspected in the case. 

The accompanying cuts will give a much more accurate idea 
of the specimen than can be gained by the verbal description. 

Plate I. gives an anterior, view of the uterus which is held in 
an upright position by a heavy wire passed into the cervix. 

Plate II. gives a posterior view. 

Plate III. gives a view of the left side thus showing a profile 
of the large nodules protruding from the anterior and posterior 
walls. 

Figure 1, is the cervix. Fig. 2. the abscess cavity in the an- 
terior nodule. Fig. 3, the sac of the right ovarian cyst. Fig. 4 
the left ovary and tube. Fig. 5, the nodule on the posterior wall. 
Fig. 6, the incision in the fundus through which the fcetus was 
extracted. Fig. 7, the foetus. These figures refer to the same 
points on each of the plates. 



JAMFS B. EAGLESON. 

Born at Chillicothe, Ohio, August 30, 1862. Preliminary ed- 
ucation in public and private schools, and taught school for four 
years. 

Graduated at P. & S. Chicago, class of 1885, entered U. S. 
Marine Hospital, Chicago, as Medical ('adet, April 1, 1885, was 
sent to U. S. Marine Hospital Service Station in Seattle, Wash, 
in 1877 as Acting Assisting Surgeon and remained in charge of 
same for 12 years, 

Served on U. S. Pension Board from 1891 to 1895. Was Presi- 
dent Washington State Board of Health from 1895 to 1897. 

President Washington State Medical Society 1897-8 Surgeon 
General N. G. W. 1893-1898. 

President Washington Medical Library Association 1898. 
Did Post Graduate work in Edinburgh and London 1892. Did 
Post Graduate work in Chicago Newport and Baltimore 1899. 



SEVERAL KINDS OF DOCTORS.* 

By G. Frank Lydston, M. D, 

"Ah, my boy! a good dinner is the greatest remedy in the 
T^orld — when your case is properly selected. To say that the 
remedy fitted my case this evening, would not do the subject 
justice. I have been hard at work to-day, I assure you, and I 
was very hungry. 

"Many cases? Well, no — a single case took up most of the 
day, for it happened to be away out in the suburbs. It was 
really too far away for me to undertake its care, but the family 
is an old one of mine and wouldn't listen to my suggestion to get 
somebody else. That's the trouble with city practice — your 
patients scatter to the four points of the compass, the first of 
every May. Your country doctor may have long drives, but he 
gets his mileage, and his patients don't float about much. When 
a two-dollar family moves away ten miles, its care is often 
inconvenient — especially if you tike the family. The worst of it 
is, your just deserts are always either too great for the patient's 
pocket, or too excessive for his liberality. It's rather hard to be 
tied down to a single case, as I was to-day. 

"Oh, yes, mother and child are doing well. 

"The father"? Come now, — that's an old joke, my boy! 
I suppose your professor of obstetrics told it to you to-day. It's 
the same old battle-scarred veteran that did duty in my college 
days. It would seem that obstetrical professors ought co be able 
to deliver themselves from the old jokes and of some new ones, 
occasionally — but they are not, apparently. 

"By the way, there's more meat in that particular old joke 
than your professor thinks. It is a very important matter to 
know whether the father is doing well or not. If he is doing 
well, there's a great fee in prospect, and if he isn't — well, you 
may go supperless to bed. For my part, I had my dinner ar- 
ranged for this morning, else I shouldn't be very good-natured 
myself to-night. 

" 'Ahem!' said paier familias, 'I'm a little short just now, 



*An excerpt from Tales of a Talkative Doctor told over the Hookah. 



134 THE PLEXUIS. 

but in a few weeks," etc., etc. — and there was my substantial' 
practice for the day sacrificed! 

"Will he settle, did you ask? 

"See here, young man, people who have two hundred and 
seventy-five days, more or less, in which to prepare for so im- 
portant an event, and fail to do so, are not likely to become more 
thrifty as time goes on. As for the 'few weeks' promises, they 
are usually mere unadulterated moonshine. 

"Let me see — the average fee in this section is from fifteen 
to twenty-five dollars. The better classes pay from fifty to one 
hundred — which is very modest, to say the least. Ten cents a 
day for two hundred and seventy-five days is twenty seven 
dollars and fifty cents. Thirty-six and a little over a third cents 
a day for the same time is precisely one hundred dollars. My! 
how hard-hearted is the physician who expects his fee prompt- 

ly'. 

"Great Scott! What a huge credit mark we doctors ought 
to have in the big book — which the pious folios say is kept up 
there somewhere! 

'Did you ever hear of a patient who couldn't get medical 
attention? I never did. Sick folks may want for flour, meat, 
coal, clothing, and shelter, bat they can always get a doctor, 
same way or other. 

"Did you ever notice that the dear public never pays the 
slightest attention to the impositions which the medical pro- 
fession allows to be put upon itself? Just let a doctor charge 
some rich fellow a good fee for work well done, however, and 
note the howl of i)rotest! To be sure, the fee for saving a 
millionaire's life is rarely more than he would willingly pay for 
the care of a thoroughbred equine favorite — but there's a howl, 
all the same. Possibly, after all, the public has of ten- times a 
more correct impression than we, as to the comparative value of 
the lives of the two animals. 

"But here comes Mrs. Weymouth. — 

"Well, my dear; you have at last succumbed to that over- 
weening weakness of your sex — curiosity. I suppose you have 
been worrying your poor little head over our occasional seances 
until you just couldn't stand it any longer, eh? — 

"No, my dear, I was but jesting. We are only too glad to 
have your charming company. You don't mind the hookah? — I 
thought not. Possibly you wouldn't object to a glass of this 



Several Kinds of Doctors — Lydston. 135^ 

punch? No? Well, you don't seem to have the confidence in the 
artist who makes it, that we have — eh, my boy? 

"To tell you the truth my dear, I should have invited ycu to 
participate in some of our various talks before, had I not been 
afraid of boring you. 

"You see, my lad, I never talk shop with my wife— she has 
bother enough, without sharing in the burdens of my practice. 

"Now that you are here Mrs. Weymouth, I hardly know 
what to talk about. I think it might be well to gossip, as women 
do at their little gatherings. They usually talk about other 
women, who happen to be absent, do they not? 

"Our conversation before you came in, was somewhat desul- 
tory it is true, but bore upon the personal experiences of many 
doctors. I don't know as I could do better than talk a little 
about the other fellow, and say something of various types of 
men whom I have met in the profession. Remember now; I am 
supposed to be on the outside, peeking over the fence, and you 
are to get my impressions just as I receive them. 

"With your permission, I shall do like everyone else who 
attempts to show m^) the other fellow — take good care to keep 
out of range of the calcium light himself, and devote my atten- 
tion to manipulating the machinery. 

"It is to be distinctly understood that nothing I may say has 
any hypercritical bearing upon Chicago physicians. They have 
been too thoroughly analyzed, and too critically classified — key 
included — by the physicians' directory, to demand any of our 
valuable time. I may say in passing, however, that the broad 
line of distinction is, that Chicago doctors are divided into two 
classes — ordinary doctors, and doctors in the Columbus building. 
The latter are a little — just a very little — lower than the angels 
^at least, this is true of those 'attic' or fourteenth- story philos- 
ophers who chase the festive microbe and brew the toothsome 
toxin in the laboratory on the top floor. Inasmuch as a number 
of lady doctors occupy offices in the sacred Columbian pile; I am 
not so sure about the relative position of the angels. 

"For our purpose this evening, it will suffice to divide the 
profession into city and country doctors: 

"City doctors are so diverse in their characteristics, that I 
must be content with a few distinctive types. None of them are 
bad, perhajDS, but some are better than others. 

"First, we have the medical pharisee — I say first; because I 



136 THE PLEXUS. 

am anxious to get him out of the way and proceed to more whole- 
some aud agreeable topics. — I will leave you to judge of his 
numerical strength and modify the picture as you may see fit — 
contenting myself by j^resenting him as I have often caught him 
witli m^^ kodak. 

"There are two kinds of medical pharisees — the lean, lank, 
cadaverous misanthroi3e, who would make an excellent under- 
study for a funeral director; and the fat, sleek and unctous 
brother, on whom the cloak of religion rests ever so slightly — 
especially on fast days. As success in a worldly way, comes to 
the lean and hungry fellow, he frequently evolves into the more 
rotund tyj^e. 

"Whether lean or fat, all pharisees' souls are cast into the 
same mould — which is smaller than a lady's thimble. If the 
materialistic theory that the living, sensitive brain is the seat of 
the soul, be correct, then indeed is a thimble large enough to 
hold that of a medical pharisee. 

"From the very beginning of his professional career, the 
pharisee works the church for what there is in it — very much as 
the coal barons do the mines — and wears his religion upon his 
sleeve, that he who runs may read. He is the true 'Christian 
Scientist," who has been aptly described as one who has no 
science — and less Christianity. He belongs to several churches 
— or rents pews therein, and manages to occupy them all, during 
the brief intervals of his exacting practice. He has a hired man, 
who, like Yorick, is 'a fellow of infinite jest," whose delicate 
sense of humor impels him to call out the pharisee in the midst 
of services, to attend an imaginary patient. 

"Did yon ever notice the pharisee's hired man? He is 
usually a red-headed Irishman of recent importation, with a 
brogue that you could spread butter on, and a voice like an 
Italian banana man. 

vSometimes the doctor's supe forgets his lines, and then 
there's trouble in the church. I once heard of a case of this 
kind: The doctor had drilled his servant very carefully, with 
the result that the Hibernian poked his head through the church 
door during the morning service and called out — 'Docthor Jones! 
Docthor Jones! Mrs. Johnson's baby do bes afther swallyin' his 
cud, an' she sez will yez come quick!' 

"But of course, the pharisee is not responsible for the 
pleasantries of his man Friday. Neither is he responsible for 



tSeveral Kitids of Doctors — Lydston. 137 

the vagaries of the clergyman, who announces from the pulpit 
that, 'through divine aid and the skillful ministrations of our 
dear brother, Doctor Pharisee, our beloved sister, Mrs. Four- 
hundred, has recovered from her serious illness.' This, by the 
way, is ,not an unusual occurrence. I heard a very amusing 
story in this connection, the other day. A certain Chicago 
clergyman announced from the pulpit — 'Our dear sister, Mrs, X, 
is suffering from a serious and painful illness. She is being 

cared for by our dear brother, Doctor G . Let us pray for 

her safety. ' Knowing the practitioner — a very prominent society 
doctor — I can safely assert that there is one preacher in the city 
who knows his business. 

"A caustic critic of medical men once said: 'Scratch a 
doctor's back, and you will find an infidel.' This was unfair, and 
for the most part untrue, but if you scratch the pharisee's back, 
you are sure to find a hypocrite. 

"The medical pharisee is very intolerant of other people's 
opinions, and, according to him, the man who does not believe 
as he does, is beyond redemption. To be sure, he prays, weeps, 
smiles, and exhorts only with his mouth, but he has as much 
faith in the efficacy of noise, in wafting souls to heaven, as does 
the average Chinaman. 

"The pharisee goeth into the various holy places on a 
Sundaj^ morning, and prays; with a mighty voice, as of sounding 
brass and tinkling symbal! And the burden of his prayer is for 
the 'welfare of the dear people of the congregation.' He asks 
'that the plague may go by on the other side,' but qualifies by 
prajang that, 'in case the affliction should come, a good and wise 
physician like himself, be selected to care for the afflicted ones. 

"If you would see the medical pharisee at his best, just drop 
a joke somewhere in his vicinity, and see the old fellow jump. 
The effect of dynamite in the hands in an over enthusiastic 
anarchist, is not a circumstance to that joke. 

"This medical i^harasee is a great stickler for ethics; he 
prates on this question ad nauseam. Strange to say. however, 
it is at the hands of this ultra-ethical individual, that the repu- 
tation of the young doctor who dares flaunt his shingle to the 
breeze in the pharisee's neighborhood, suffers most. He it is, 
who in consultations, makes diagnoses by intuition, and damns 
the young aspirant for medical fame, with faint praise, or 
covertly thrusts a blade of uncharitable criticism under the 



138 THL PLEXUS. 

young doctor's fifth rib. He it is, who says, with a scornful 
intonation, as he feels the pulse of a patient, both of whose 
lungs are solidified clear up to his neck. 'This is not a case of 
pneumonia; paraphernalia of this man's brain has become 
obfuscated, with a resultant trans-mogrification of the dia- 
phragm, and that's what makes him short of breath!' — And then 
the poor patient turns his face to the wall and dies, in the 
sublime conciousness that he at last knows just exactly what's 
the matter — for hath not the renowned Doctor Pharisee spoken"? 

"It is the pharisee who gets the weeping crowds and the 
longest funeral procession when he dies — the only honor that 
we grant him with any degree of cheerfulness and resignation 

"Who is more worthy of respect than the consistent 
christian, who has the courage of his convictions, yet is bread 
and catholic in his tolerance of the conscientious opinions of 
others? — And who is more contemptible than the medical 
pharisee? 

''The pharisee is fond of alluding to himself as a 'self-made 
man.' He may be right, but his adornation of his maker is no 
evidence of piety — besides, the job is not always a good one, 
and is nothing to brag about at its best. And does not the bible 
forbid the worship of brazen images? 

"But, after all, the pharisee is not a fair type of the city 
doctor — he is but a noxious weed in the broad field of city 
i:»ractice. If the weed could only be torn up and destroyed, 
there would be more of a living chance for worthier plants. 
Unfortunately, however, the pharisee is popular; he lives osten- 
tatiously and drives a stylish rig — all of which takes with the 
masses. And the struggling young doctor must keep up with 
the procession or go to the wall. Many a doctor's family has 
gone threadbare, and even hungry, in order that its bread-winner 
might have an even chance with the medical pharisee in the 
struggle of existence. Only a doctor, knows the heartaches and 
disappointed hoi:)es that often lie just beyond the swell turn-out 
of the city doctor. Things sometimes look very different when 
the scenes are rolled away, and the bare boards of of the doctor's 
life are revealed. Let those optimistic idiots who say that the 
doctor makes his money easily, try a hand at general practice 
for a short time and they will be a little more liberal with the 
profession " 



Several Kinds of Doctors — Lydsion. 139 

"There is another individual who is an excellent running 
mate for the pharisee — although they can hardly be said to be 
well matched. This fellow is popularly known as 'Dock.' As 
we are drawing botanical comparisons, we might call him 'Dock- 
weed.' He, also, has an exacting practice; but, in lieu of work- 
ing the church, he spends the intervals of his arduous pro- 
fessional labors in working for the cause of prohibition— by 
surrounding the enemy, so to speak. His capacity for whiskey 
is enormous, and his popularity with ward politicians corres- 
pondingly great. 

"This is the man of whom the laity says, 'He's the best 
doctor in the neighborhood — when he's sober.' I never could 
quite see the logic of this assertion, but everybody has heard it, 
or something similar. As the calcium light of calm reflection 
glitters on the rich carmine of his proboscis, what do you think 
of himV Does he not look wise? Really, I fear he knows 
enough medicine — to be dangerous! This good doctor — 'when 
he's sober' — is a fruitful theme, but it makes me so weary to 
think about him that I will do no more than briefly introduce 
him, feeling sure that you will be surprised to learn that he is 
an old acquaintance — for I am certain that you have met him 
before. 

"This much I will say, however: When anybody tells you 
that a town drunkard can be a good doctor; believe him — pro- 
viding he can show a correctly-drawn death certificate for the 
aforesaid doctor. A drunken doctor is a good doctor, and can be 
trusted, when he's like Mark Twain's good Indian— very, very 
dead! And when such a man prate ; of his greatness, as he is 
likely to do, for he is often one of those men with genius written 
upon his brow — 'written there by himself — and complains that 
the world at large, and the profession in particular, can not see 
it, let us be thankful that some peoj)le, in some directions, get 
just about what they deserve in this world. 

"And now that the medical pharisee and the 'dock' have 
been weeded out — metaphorically — alas! that it could not be 
literally — you are perhaps wondering whether there is such a 
thing as an ideal city doctor, and what he may be like. I have 
an ideal, which has often been realized in the medical profession. 
Although the particular embodiment of the ideal of which I 
shall speak has long since passed away, the type is always with 
us, and you, perhaps, may ^now such a one. He was of a type 



UO 2 HE FLIC.WS. 

which is very familiar to many people as 'Our family doctor' — 
even though they may not fully appreciate him. 

"The man who was to me an ideal physician, had grown 
gray in the service of humanity, and had seen less deserving 
men among his classmates, push forward to wide reputations 
and great financial rewards, whilst he remained in the same 
plodding path he entered on leaving the hospitals. He was not 
popular in the early days of his practice in the North, for he was 
a Virginian, and the people of his colder northern environment 
were rather slow to forget that he had once been a 'rebel 
surgeon." He had seen his guiding star of duty in the care of 
the suffering 'boys in gray" — how well he performed that duty, 
the stricken soldiers of the Confederate army of the Tennessee 
could testify. When popularity did come, it was not such as 
brings affluence, or even financial independence. He who had 
been reared in wealth and luxury, was doomed to be 'a poor 
man"s doctor" all his life. And' he was indeed, a poor man's 
doctor, for with him, fees were a secondary consideration. As 
with many others of Utopian ideas, our kind doctor"s generosity 
was more often abused than appreciated. The axiom that 'The 
gift horse is ridden to death," is nowhere more aptly illustrated 
than in the practice of medicine, and ever stands as a solemn 
protest against the doctor" s mixing too much sentiment with his 
daily work. 

"Being a poor mans doctor, is equivalent to being a poor 
man, and so my city doctor had little occasion for display. 
Satisfied was he, with a sound coat to cover his back — albeit 
'twas often threadbare — bread for his babies, and a clean slate at 
his butcher's. And yet he was talented — indeed, he was the 
most philosophical physician I ever knew. But the rich did not 
appreciate his merit, and he was too busy with patients of less 
distinction, to thrust himself before people of greater social and 
financial importance. 

"How often, in my student days, I have known the old man 
to rise of a cold, tempestuous midwinter's night to face the icy 
s+orm, in behalf of some poor, sick woman or suffering child, 
whom he well knew would never be able to compensate him! 
Sometimes, I would say to him: 'Doctor, the head of that family 
could pay you if he would; he drinks, and gambles his money 
away I I wouldn't go if I were you!' And then the kind old 
doctor would shake his head reprovingly, and say, 'William, my 



Sever il Kinds of Doct9rs. — Lydston. 141 

boy, never let the women an:l children suffer, even though the 
men are rascals! Be all the more ready to go, because you have 
an opportunity to redeem your sex — it needs it badly enough.' 

"And this practical lesson in philanthropy came from the 
lips of an agnostic! 

"When the lean and bloodless pharisee meets such a medical 
paradox uj^on the broad highway of life, he gathers his funeral 
garb more closely about him and — goes by upon the other side, 
as though in fear of the contagion of expansion of heart; while 
his more unctions brother pats himself upon his portly front in 
sublime self-satisfaction, and thinks of new schemes, whereby 
our Caesar may become more great." 



"Forty years of unremitting toil brought feebleness to my 
city doctor, yet he still followed the narrow path of professional 
duty he had marked out for himself in early life. Someone had 
said in his later years: 'It is not wise to trust the old doctor toj 
far; the silvery crown of age does not always bring wisdom, nor 
does the feebleness of senility insure a keen eye, an unerring 
judgment or a steady hand. Do thou employ a younger and 
more learned physician.' But his faithful patients replied: 'He 
has served us passing well; he has never abused our confidence, 
nor has he ever failed in the varied trusts and responsibilities we 
have put upon him. — He has succored our lives, and cared for 
our treasures— our children. — He has guarded our reputations I 
These things do we value more than a knowledge of new 
theories, that are here to-day and there to-morrow; more than 
"the optic sharp. I ween, that sees things that are to be seen.'* 
Bravely, faithfully and uncomplainingly, has he borne the woes, 
of our children and the burdens of our wives; most steadfastly 
has he shielded the family skeleton from the gaze of a carjDing 
and cruel world — this is more to us than all the fads of modern 
imaginations!' 

' ' He died in harness, did this dear old man, and almost to 
the very day of his death, he plodded about through the stormy 
days of our early spring weather, ministering to the wants of 
patients, none of whom were half so sick as was he himself. He 
finally succumbed — the pitcher had gone to the well for the last 
time! And when the end came, his brother physician looked 
wise, and gave learned names to the rest that had come after 
forty years of constant and self-sacrificing labor for humanity's. 



112 THE PLEXUS. 

sake. Surely his toil had beeu unselfish, for he received little 
reward in this world — and his materialistic philosophy held out 
no hope of recompense in the next! But who shall say that 
oblivion was not to him a fair reward — a well earned rest.? 

"Few indeed, were the silks and satins, in the little gather- 
ing that paid the last mournful tribute of respect to the city 
doctor. Men in threadbare suits, and women in rusty black, 
looked down upon the face of the good and wise physician, and 
felt that their best friend had gone — not to their heaven perhaps, 
but, if he himself was right, to an immortality of another kind, 
free from fear of iiunishment or hope of reward. 

"Beside him wept the careworn mother, who once had heard 
the chime of the golden bells across the mystic sea — who had 
once seen old Charon with his phantom bark, ready to waft her 
to the eternal shore — that was all too near— and had been saved 
to her loved ones by the helping hand of our city doctor. And 
who shall say he was, or was not, kind? And the little children, 
whose youthful trials in the battle of life he had helped to bear, 
seemed to reach out their tiny, eager hands, to call the old man 
back! To them he was a hero, of most colossal mould, whose 
fame and great deeds will ever be a sanctified and beautiful 
memory in the household! 

"Good and wise old city doctor, friend of the poor, champion 
of the struggling young practitioner, kindest and wisest of 
preceptors — here's to thy memory! Thy life was indeed an ideal 
that the many may not hope to attain, but which is even now, 
being exemplified by a devoted few, whose lives — whether ruled 
by the sublime faith of Christianity or by the universal milk of 
human kindness that knows no creed- -are inspired, not only by 
the genius of medicine, but by a practical philanthropy which 
makes the profession of medicine the noblest under the sun." 



THE QUESTION OF HIGHER EDUCATION. 

With the announcement that a prominent medical college in 
the West, will, in the course of a very few years, demand that a 
Bachelor's degree be attained before an applicant is admitted to 
the study of medicine within its doors, comes the question to the 
present as well as to the future medical man, is this debarring 
from the study of medicine men of ability, who, were it not for 
financial conditions in which they find themselves, would be an 
honor and a credit to the medical profession? Unquestionably 
it is of the greatest importance to have the professional men, 
men of learning and men of ability, capable of acquiring a 
Bachelor's degree in any good college or university, but the 
expense incidental to the obtaining of this degree will preclude 
in the minds of many the study of medicine, which in itself is 
not an inexpensive degree. 

In the last legislature a bill was brought up to have a 
uniform standard of excellence necessary, before a Bachelor's 
degree should be granted; an amendment was offered that the 
State University establish such a standard by its own curri- 
culum, but it was not long before the small colleges throughout 
the state protested that with their meagre corps of instructors 
and their inadequate equij^ment they could not hope to live up to 
the standard established by a university with the state of Illinois 
behind it. The point was well taken and we are still seeking a 
standard, but even when found shall it be adopted by medical 
schools as a preparatory course incidental to the study of 
medicine. 

Dr. Francis Dickinson in a recent number of the Daily Justice 
Record touches on this question somewhat in speaking of evening 
schools. She says: 

"New occasions teach new duties and it is high time that the 
university trustees elected by the people, who have so hansomely 
provided for the farmers' interests in the Agricultural Depart- 
ment at Champaign, Illinois, with the large appropriations made 
by the last legislature, should turn their attention to the crying 
need in the City of Chicago for education in the elements of the 
sciences in the evening, and so conduct the courses that the time, 
energy and money spent shall be credits which belong to the at- 
tainment of the B. S. degree." 



•Alurppi Deparbmepb. 



Continuing- the policy adopted last month we publish the 
names of the graduates of the years "8s, "89, "90, '91 and '92, who 
have sent us a biographical sketch. Some have come in from the 
years prior to "88. We will begia with "83 — as soon as we have 
finished the list. Last month we asked the gentlemen appointed 
as assistant secretaries to write accepting the appointment. Two 
have replied — we hope to hear from many others within the next 
week or two. 

The secretary has determined to be possessed of accurate 
information of seventy-five per cent, of the graduates by next 
commencement. This is, beyond question, desirable — is it pos- 
sible of accomplishmenty It is if the graduates and especially 
the secretaries will co-operate. 

We will express blanks to each secretary together with a list, 
of the graduates of his year. He will send a letter to each of 
these asking information of the individual addressed not only as 
to himself but as to any other graduate of whom he may know. 
The graduates have been card indexed and nothing will be easier 
than to keep close track- of the information that comes in. 

One half of the graduates do not subscribe to the Plexus, 
nor in anyway participate in the work of the Alumni Association. 

Realizing that a very large percentage of its subscribers are 
and will always be graduates of the school, ^ he Plexus endeav- 
ours to make itself as valuable as possible to them. In addition 
to the regular scientific matter, there will always be an article 
from the pen of an alumnus. 

'86. Dr. J. Kaszer, Plymouth, Indiana, has recently called at 
the college. 

'87. JasP. Way writes "wishing old P. & S. and the Plexus 
every success, etc."' 

'88. F. C. E. Mattison, Pasadena, Cal. 

'89. Harvey R. Cronk, 27 E. 30th. St., New York City. 

Albart S. Gray, 103 State St., Chicago.— Dr. Gray has ac- 
cepted his appointment as secretary. 

'90. S Venning Dahl, 822 N. Western Ave., Chicago. 



Alumni'. 145 

'Oscar Dodd, 103 State St., Chicago. 

Jas, P. Ellis, Augusta, 111. 

Jas. J. Howard, Columbus, Wis. 

Wm. F. Hooper, Magazine, Ark. 

Ernest M. Mills, Colchester, 111. 

'91. Edwin G. Earle, 91 Lincoln Ave., Chicago. 

Robt. Lee James, Blue Island, 111. 

John J. Scblawig, Jr. , Souix City, Iowa. 

A. A. Hassell, Put-in-Bay, Ohio. Has taken charge of the 
hospital there. 

'92. Julius M. Abelio, 395 S. Halsted St., Chicago. 

Francis R. Smyth, Bis^ark, North Dakota. Dr. Smyth was 
president of the North Dakota Medical Society in 1898. 

Gerhart S. Seim, Blue Island, 111. 

R. Fred Trockmorton, Derby, Iowa. 

'94. Dr. E. A. Planck, writes accepting his appointment as 
secretary for this year. 

"95. Dr. Jos. Beck is at Prague. 

'96. Dr. I. J. Strauss calls our attention to the fact that no 
secretary for 1896 has been published. This omission is difficult 
to understand. Dr. Emil Beck was on the list for 1896. 

"99. Dr. Wm. Lerche is in Europe studying. 

Dr. Wm. L. Ballenger and wife, have returned from a summer 

in England. Dr. B attended the International Congress of 

Otologists which met in London, August 8th to 12th. Reports a 
fine time and a splendid meeting. Representative Otologists 
from every civilized country were in attendance at the meeting. 



ICED CHLOROFORM. 

Iced chloroform has been used as an anassthetic in Professor 
Shorburg's clinic, in the Julius Hosf)ital at Wurzburg, Bavaria, 
in over 14,000 cases without a single unpleasant result. The ad- 
vantages claimed for this preparation of chloroform are the 
•quickness of its action, its com]3arative freedom from danger, and 
the absence of nausea and depression so common with other 
anaesthetics. 



NEWS NOTES. 

Doctor G. Frank Lydston, Professor of Genito-Urinary Sur- 
gery and Veneral Diseases of this School was recently reappoint- 
ed surgeon of the 2nd Regiment with the rank of major, by Adj- 
utant General Reese, upon the recommendation of Colonel Stuart. 
Major Lydston is one of ohe few members of the old staff who 
were reappointed. He was surgeon of the 2nd Infantry, 111., 
U. S. v., during the Spanish- American war; was later promoted 
to chief operating surgeon of the 2nd Division Hospital under 
General Lee, at camp "Cuba Libre," Jacksonville, Florida. 

* * 
* 

Dr. J. M. G. Carter, Professor of Clinical and Preventive 
Medicine, has returned from his tour abroad, which he thorough- 
ly enjoyed. The rest and recreation has benefitted him very 
much and jirepared him for the long siege before him, the eight- 
eenth annual course of instruction. The doctor sent us an unus 
ually complimentary letter regarding the appearance of the 
Plexus for which we thank him kindly. 

* * 
* 

Mr. J. S. Tomlinson, "Genial Joe" as he is known to the 

students, has been performing the duties of actuary during the 

absence of Dr. D. A. K. Steele, and has been doing his work 

well, as the appearance of the interior of the school will show. 

It seems natural to see him around again. 

BOOK NOTICES. 

Tales of a Talkative Doctor told on the Hookah, by G. Frank 
Lydston, is an extremely interesting book. The Doctor in hi& 
inimitable manner tells of stories and incidents that happen, no 
doubt, to all i^ractitioners of medicine and embryo doctors. A 
chapter or two interspersed with the heavy reading which all 
doctors are compelled to read, to keep up to date, is to the tired 
mind, what a dainty desert is to an appetizing meal. In another 
part of this journal we print an excerpt from the chaj^ter on 
"Several Kinds of Doctors." 




FRANK B. EABLE, M. I). 

Professor of Obstetrics, College of Pliysiciuns and SurReons. 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 

UNIVERSITY OF ILLINOIS, 



^VOL. V. SEPTEMBER 20th, 1899. N0.5. 



LIGHTS AND SHADES IN THE DOCTOR'S CAREER. 

By Frank B. Earle, M. D., Professor of Obstetrics. 

Opening Address delivered at tlie College of Phj'sicians and Surgeons 
Chicago, Sept. U), 1899. 

Ladies and Gentlemen of the Class and Friends of the In- 
stitution: — Will it be presumption on my part if I say we are as- 
sembled here to-night to witness another opening session of a 
college which occupies a conpicuous place among the first med- 
ical institutions of this country"? Should not we feel justly proud 
that an institution, youthful as is this, 'Can boast of so enviable a 
position in the medical center of America"? Surrounded as we are 
and accessible to the finest hospitals, it behooves us to stand as 
the exponent of medical science and skill. I do not come before 
you, however, to glory in the achievements attained nor to inflate 
you with our future conquests. Suitice it to say that ours is a 
policy of progression and expansion, and our platform so broad 
and so liberal that we welcome competition. 

Hy far the most important 2:)ersons here present to-night are 
you who have returned from a few months of rest to resume 
your studies and you wdio for the first time are en tering upon 
your student course. It is to you particularly to wdiom I desire 
to speak. You will pardon me if I appeal somewhat to your 
youth and inexperienc?. You are here in a large city; some of 
you, presumably, for the first time. You have been following 
the various occupations of students, clerks or teadiers. and, hav- 



148 THE PLEXUS. 

ing outgrown your former surroundings, now seek the broader - 
field. 

You, my friends, will ofttimes find your paths beset with 
difiiculties — thiags as you would not have them— people not as 
they seem. Surrounded as you will be by the bustle and hurry 
of a great metropolis, you will nevertheless at times find a ' 'great 
city a great solitude."' 

One of the first requisites of a student is to be oblivious to 
his surroundings. Still, in this seemingly infinite magnitude of 
people and space, you will soon find yourselves comfortably lo- 
cated; your college will be your home, your fellow-students and 
teachers your friends. 

Seventeen years ago this month I sat where some of you are 
now" sitting and listened to an address by Prof. A. Reeves Jack- 
son. It was the occasion of the opening of this college for its 
first session. It was also the first time I had stepped inside of a 
medical institution and therefore a memorable event in my life. 
Since that time, having passed through the successive stages of 
student, j^ractitioner and teacher, opportunities for observing 
the development of the college — the success and failure of many 
an alumus and teacher — have been a sourceful theme for reflec- 
tion. Nor has this been the only source from which information 
has been garnered. During these years of active practice among- 
all classes, and with a considerable knowledge of medical men, I 
have contemplated the various questions, conditions and circum- 
stances which shape, to some extent, the destiny of men 
of medicine. Never was there a more truthful statement than 
that which Brutus ut+ered when he said: 

"There is a tide in the affairs of men 
Which, taken at the flood, leads on to fortune; 
Omitted, all the voyage of their life 
Is bound in shallows and in miseries." 

On this occasion then it would seem not inappropriate to in- 
vite your attention to the various phases of the physician's life. 
The dark and the bright side of many, if not of all, doctors- 
lives would be interesting food for thought. 

I have no doubt that many of you women and men who have 
elected the profession of medicine for your life work have your 
ideal. You may have acquired your ideal by a knowledge of 
the profession in general, by your familiarity with the lives of its 
most noted men or by the more limited association of your proe- 



Lcghts and Snades — Earh\ 14:9 

ceptor. Howsoever you have come into possession of this, you 
have conceived an idea as to the particular line of work which 
you will master, and you have formed your conception of what 
kind of a physician you will be. Possibly you have settled on a 
specialty, possibly you will be an "all-round doctor,"" similar to 
an individual on one of the islands in Puget Sound, who adver- 
tises as follows : 

"Legs and arms sawed off while you wate without pane."" 

"Childbirth and tumors a specialty."" 

"No odds asked in measles, hooping-coff, mumps or diarrear."' 

"Bald-head, bunions, corns, warts, cancer, and ingrowing 
tow-nales treated scientifically."' 

"Coleck, cramps, costiveness and worms nailed on sight." 

"Wring- worms, pole evil, shingles, moles, and cross-eye 
cured in one treatment or no pay."" 

"P. S. Terms: Cash invariably in advance. No cure no pay.'" 

"N. B. (Take Notis.) No coroner never yet sot on the re- 
mains of my customers, and enny one hiring me doan"t 
hafto be good layin up money to buy a grave-stone. 
Come one come awl."" 

Not for a moment do I question that within this room there 
are those who have determined to sacrifice all personal aggran- 
dizement for the nobler purpose of administering, physically and 
spiritually, to the unfortunate and ignorant. Nor can it be 
doubted that here are some who picture themselves as the med- 
ical advisers and attendants of the influential — whose patrons 
belong exclusively to the "Pour Hundred"" — who would visit 
none but the palaces of the opulent; whose ideal is the attractive 
epuipage, the snug account at the First National Bank and a 
mansion on the Lake Shore Drive . We have known such stu- 
dents; we know snch physicians. But do you for a moment 
imagine that it is but a step from such a student to such a physi- 
cian? If so, permit me to disabuse your minds of so erroneous 
an idea. 

I would not extenuate your ideal, however, but will ask you 
to make it illimitable. For neither can a physician who has his 
ideal clad with the cause of humanity too soon awaken to the 
conviction of his limitations; the hovel, the hut. the palace, and 
alike the battlefield must awaken his sensibilities. 

The self-sacrificing physician, administering to the wants of 
the unfortunate, is a grander picture than was ever painted by 



loO THE FLEXrS. 

Raphael oi- Angelo. But, alas! how infrequent is his eulogy! 
Standing, as he must in the practice of medicine, by many a bed- 
side watching the ebbing life, he must be immovable to any ex- 
tei-nal emotions, regardless of the heart. Such acts of immola- 
tion are alone part of a physician's life. 

Did you ever hear of a physician becoming famous in a fort- 
night y Unlike authors, inventors and political stars, who 
awaken some morning and find themselves famous, the medical 
men of great repute are only brought before the world after 
years of self-sacrifice and untiring devotion to their work. Jen- 
ner. Lister, Koch Pasteur, each devoted patient work to his 
discovery, and men of our own country and city have expended 
unlimited time and energy in perfecting an original discovery or 
operation. 

You come here with your inherited capabilities and tenden- 
cies to acquire from this college a degree which represents a 
medical education. The object of this training should provide 
a wide exercise of your capacities and a right direction for your 
tendencies. And here, it may be said, that systematic work alone 
will accomplish this. Every physician of renown has evolved his 
particular systematic method when a student, and with some 
modifications has maintained it in his work thereafter. You can- 
not tell what the potentialities of your mind may be, for the 
mind only requires release to be brought into action. Study then, 
andrelea.se the latent force and utilize it in the greatest of all pro- 
fessions in original research, improvement in technique, and so 
on. You are liere for one piirpose and one onl.y — study. Like 
those who have jireceded you, "the more you study, the more you 
will discover your ignorance." 

To-morrow you begin in dead earnest. While here we will 
compel you to reason and to work; not in a mandatory or dicta- 
torial way, but by interesing and aiding you, so that your work 
will be a pleasure. You have committed yourselves to our keep- 
ing; we are your sponsors; we are to shape your future by fitting 
you for your work in the broader and nobler siihere. 

Permit me to give you one 2:)ractical word of advice which in 
your chosen profession is of great personal importance. In the 
midst of your ardor and enthusiasm, which certainly will often 
rise to a great degree, remember the care -of your health. What 
is more befitting the doctor of medicine than to be himself a 



Jji(j]its and S/iadrs-- Eailr. 151 

representative of good healthy What will you have with which 
to identify yourselves as practitioners if it be imj^airedy 

I have no doubt there are many among you so ardently bent 
on acquiring your education here who will scarcely take the time 
to look after their physical welfare. But it is an item that must 
be attended to constantly. There is no achievement you can 
accomplish that will equal perfect health; and practically nothing 
can be acquired without it. 

In medicine there is no place for the laggard. The life of 
the successful physician is a period of hard and almost unceas- 
ing labor. Unlike the skilled mechanic who works eight hours 
for six days a week (except that possibly he gets Saturday after- 
noon off without a reduction of his weekly salary) and is abso- 
lutely certain of his wages, the busy physician more frequently 
works sixteen to eighteen hours seven clays each week, and takes 
chances on his pay. He works while the nation slumbers; while 
the nation takes its holidays and Sundays- The setting sun and 
the dawning day oft find him at his post. Whether the day be 
cloudy or bright, .whether worried by domestic cares or burdened 
by professional responsibilities, he cannot falter. In many in- 
stances his untimely demise can be clearly attributable to his 
constant devotion to duty. 

Has it ever occurred to you thai great men in medicine are 
often those remotely located from the marts of commerce and 
the university centers? Have you not known of some one in a 
comparatively remote locality whose talents would have graced 
a much broader field, and Avhose devotion to his peoj^le and his 
profession formed the largest amount of his annual stipend? 
Not alone in the metropolis do we find the skillful, although nat- 
urally from the frequency of cases and events would we exj^ect it. 

Simplicity and quietude of rustic life have often been de 
pic ted and admired in poetry and song, but it is none the less 
true that the rural districts have demonstrated of what the re- 
sources of a rustic condition are capable. Indeed, some of the 
greatest steps in the advancement of medical science have ema- 
nated from men "far from the madding crowd" and compara- 
tively unkncwn. True it is that usually large cities afford the 
most advantageous po.sitions for invention and discovery in the 
medical world, as in the world of mechanics; but in the former, 
as well as the latter, we find a startling truth or a great operation 
discovered or perfected by some one in comparative obscurity. 



152 THE PLEXUS. 

2soticeable among these was Dr. Ephraim McDowell, who per- 
formed the first ovariotomy, in Danville, Ky., in 1843. Many 
other instances of a like character could be cited. 

Have you read "A Doctor of the Old School," in "Beside the 
Bonnie Brier Bushf If not, do so as a part of your medical 
education. The character of Dr. MacClure is as typical as it is 
unique. With his unselfishness, his honesty and devotion 
to his i^eople, the old doctor was the honored and endeared 
of the entire section. You may likewise exert a powerful influ- 
ence on a community or the medical or surgical world. You too 
may startle the medical universe, and confer unlimited good on 
humanity by some discovery. There are numerous instances of 
an upheaval in the profession by the announcement of a new 
theory. Take, for example, the essay of Oliver Wendell Holmes 
on "The Contagiousness of Puerperal Fever," as published in 
1^43. He was most bitterly opposed by his confreres, Meigs and 
Hodge, who scoffed and ridiculed his advanced ideas. But as 
truth is sure to win, although perhaps not for a long time, his 
ideas proved correct, and his article of more than a half century 
ago stands pre-eminently a classic today. 

But have I not dwelt too long on the serious side of the phy- 
sician's lifeV There is much sunshine and happiness for him who 
faithfully and intelligently discharges his professional duties; 
there are attractive phases that, if successful, come in his middle 
life, but more frequently in his maturer years, and as the result 
of his devotion to the duties and responsibilities imposed upon 
him. When at length the time has come for a reward of knowledge 
profound and a recompense for all the trials and disappoint- 
ments, then do we see the doctor in an entirely different phase. 
He shines by direct light from the awe-inspiring throne of self- 
reliance. In the profession of medicine much depends on this 
qualification and its companion condition, self-esteem. Self-es- 
teem is one of the essential characteristics of human life, and has 
made many a physician endurable where he would otherwise 
have been only tolerable. Therefore, I can see no reason why, 
after having acquired a specialized knowledge, he cannot, with- 
out being pedantic and without giving offence, cultivate that 
inestimable quality, self-esteem. 

There is no position more enviable than that of the success- 
ful, honored phycisian in the advanced years of his life. It is at 
this time that he reaps his largest pecuniary gains — the envy of 



Lights and ^Shades — EarJe. 153 

the younger men, the comfort for his declining years. It is at 
this time that positions of honor and responsibility are placed at 
Ms disposal. It is too the time when the younger men of the 
profession seek his kindly advice and encouragement; it is also 
the period when he can gracefully rest on the laurels of his 
earlier years. He has the esteem and good will of his people 
and his associates; he has the consciousness of having abundantly 
discharged his obligations to himself and to his jjrofession. His 
time can be so distributed that he may indulge his desire for 
music, literature and travel. 

One of the features of the physician's life that is imperfectly 
appreciated by those never having practiced medicine is the re- 
lation of the physician to his patient. It has been previously 
said that he has the esteem and good will of his peoj^le. This 
but suggests the happy position of the one toward the other. 
We can assert, and that too without fear of dispute, that there 
exists between the physician and his patients a feeling of mutual 
dependence and loyalty and trustfulness vrithout parallel. To 
whom does the old patient go in the distress of domestic or tinan- 
cial trouble but to his physician^ To whom does the worn and 
wrecked mother appeal but to h^r sympathetic, open-hearted, 
ever- willing family physician V Not only is he the custodian of 
the physical being but of the domestic, the mental and many 
times the spiritual condition as well. No one can know, nor 
even approximately estimate, the love and respect that the phy- 
sician commands from those with whom he has so long been 
associated. From the ragged urchin on the street who recog- 
nizes and hails him as he passes to the tottering form of the aged 
grandparent, that love and confidence and respect is unequaled. 

There is a sunny side, then, in the physician's life. Many 
times he alone realizes its magnitude and the happiness it means 
for him, but, though not apparent to those about him, it never- 
theless exists. Then too, outside of his regular professional 
duties the doctor is no unimportant personage. He is referred 
to, his advice sought and his influence felt upon many questions 
outside of medicine. Socially he has the entree to all important 
functions. By virtue of his ability and suavity his presence is 
sought by the cultured and the ostentatious. 

The field of politics has been invaded by numerous members 

of the profession. Some extremely clever work has been ac- 

• complished, and in recognition of ability we have sent our mem- 



154 THE rrExrs 

bers to Congress, the Senate, and there are rumors of a medical 
Governor for our State. 

All charitable institutions should have as superintendents 
medical men, not as a reward for political service but by reason 
of the fact that they are not only more in sympathy with the 
work but because t'hey are better fitted. 

Let me remind you that President McKinley recently recog- 
nized the profession in an appointment to one of the most per- 
j)lexing positions in our newly acquired territory. I refer to the 
appointment of Maj-Gen. Leonard Wood as Governor-General 
of the Province of Santiago. 

In the literary world w^e find the works of numerous physi- 
cians. True it is that most of them forsake medicine for the less 
laborious and more congenial occupation, but Mitchell would 
never have written "Doctor and Patienc" nor Conan Doyle his 
collection of medical stories, "Around the Red Lamp, if they 
had not been medical men. Doyle received his inspiration for 
"Sherlock Holmes," his greatest work, from one of his college 
professors. 

In matters pertaining to the church the physician he is fre- 
quently a conspicuous figure — if not spiritually, certainly finan- 
cially, for his income is habitually overrated and he is therefore 
importuned frequently and persistently to aid benevolent j)ur- 
poses. And w^ho is more charitably inclined than the physician? 
His constant association with disease, distress and the unhapjii- 
ness of the human heart refines and softens his nature and develops 
the sympathetic trait in his character so that he not only gives 
his time but often his financial aid when he can illy afford to do 
so. It is nevertheless a fact that he gives willingly and gener- 
ously and takes pride and pleasure in being able so to do. 

In endownnents to charitable institutions he is not sur- 
passed. In almost every college, hospital and training school 
in this country will you find evidence of his generosity and 
loyalty. Only recently has this college, together with other in- 
stitutions of this city, been the recipient of a generous endow- 
ment, the donor. Dr. R. L. Rea, having been for many years 
professor of anatomy in Rush and later professor of surgery in 
this school. Stern of nature, relentless in combat, he none the 
less possessed to an uncommon extent the spirit of generosity 
and unselfishness so common to medical men. Well do the old er 



Lujhts ami Shades — Karle. 155 

graduates of this college i-ecall his. marked consideration for, 
and attention to the clinic patients. 

Under ordinary circumstances of life the amount of money 
which one can accumulate is the estimation of his success. The 
business man is rated in the commercial world by the number of 
dollars for which he can write his check. This is the rating of 
his success. Not so, however, with the physician. You cannot 
estimate his success by the amount of hi>-s money. No one would 
have the temerity to assume that medically the profession was a 
failure, and yet it is a well- recognized fact that financially the 
average physician is a failure. This is not due to a lack of 
ability but rather to the fact that his attention is engrossed in 
the development of his talents professionally instead of the 
accumulation of a fortune. There are other factors besides the 
question of finance which must be considered when we attempt 
to measure his success. He may be bankrupt financially but 
possess a knowledge and experience of in estimable wealth. He 
may be a pauper and yet have accomplished the most wonder- 
ful thing of his century. The ideal jDhysician is: 

First: One who has mastered his art. 

Second: One in whose ability and dexterity the profession 
has unlimited trust and for whose personality the profoundest 
regard. 

Third: One who commands the respect and devotion of his 
Ijatients; and 

Fourth: One who acquires a competency equal to his 
personal demands and sufiicient for the care of those dependent 
upon him. 

The sublime and crowning characteristics of the physician 
must be his self-reliance, his great directness and extreme sim- 
plicity. 

"He should be among men supremely intelligent: among 
teachers, absolutely unselfish; among thinkers, purely imper- 
sonal; among friends, inflexibly faithful." 



SOME FEATURES IN SURGICAL PROGRESS. 
By Wm. M. Harsha, M. D., Chicac^o. 

When we remember that suro^ery as a distinct department 
dates back but a century, we may speak with pardonable jjride 
of its attainments; but wlien we consider that the essential facts 
of astronomy have been well known for many centuries, while 
onl}' within the last twenty-five years have the most vital facts 
of medicine and surgery been learned, our pride becomes ques- 
tionable. It seems strange that human intelligence has been 
guided along paths that have led to figuring out the wanderings 
of the stars, while men died by thousands from dirt and prevent- 
able infection in theii immediate environment. The evolution of 
asepsis is the most gratifying phenomenon the present genera- 
tion of surgeons has witnessed. Along this line of surgical 
cleanliness much remains to be taught the people. The Greeks 
and Romans were greateridevotees of the bath than later peoples. 
The Japanese have carried into practice a similar wholesome 
habit, but it remains for all people in a spirit of self -conservation, 
if for no esthetic considerations, to adopt permanently the prac- 
tice of personal cleanliness in accordance with the old proberb 
that "cleanliness is next to godliness. '" 

Bacteriology, that important department of biologic study, 
has had its rise in the same quarter of this fast-fading century, 
and its application in a practical way has not only been the 
greatest boon to internal medicine, but sheds its glory on the 
surgical side as well. In surgical advancement means of preven- 
tion are of the greatest importance, and through this avenue has 
come the treatment of diphtheria by antitoxin, which, when 
properly appreciated and generally practiced, will almost entirely 
obviate the need of intubation and tracheotomy. The discovery 
of antitoxin has, however, placed a greater responsibility on the 
general practitioner than he has ever before had to assume, 
since the successful treatment of diphtheria implies an early diag- 
nosis. Serum-therapy has demonstrated preventive qualities m 
tetanus, and much may be reasonably expected in other surgical 
diseases. Among the further advances the use of the Roentgen 



feafnrrs in Sxrgical Progress. 157 

X ray has been extended to the location of stone in the kidney, 
tumors of the brain, chest or abdomen, and is claimed to aid in 
locating- tubercular lesions in the lung even, while improvement 
in methods and instruments are such as to eliminate the dangers 
•of former long sittings. The extensive use of normal salt solu- 
tion has proven its great value in so many conditions that it 
should be provided for in every operative case. One of the great 
advances of recent years throughout the smaller cities is the 
establishment of hospitals where much of the surgery that was 
formerly done only in the larger cities is now practiced. This 
evidences a wider diffusion of surgical proficiency than has ever 
been know^n before, while never did students have such oppor- 
tunity for acquiring surgical skill as they now have in the col- 
leges and hospitals of this country. 

To go into details is impossible in this place, but mention 
should be made of recent great improvements in diagnosis and 
treatment of intracranial and abdominal lesions. Removal of the 
entire stomach has been done several times, and many more 
cases of intestinal lesions are treated surgically than ever before. 

Research is being made in every laboratory with a view to 
clearing up the etiology of 'cancer, and the prospect is not dis- 
couraging that cancer and sarcoma may yet be taken from the 
list of tumors to be classed [as infections. Schleich has intro- 
duced new anesthetic agents thatjpfomise more prompt action 
combined with greater safety to^the patient. 

The conquests of surgery have been largely made by American- 
surgeons, and it is gratifying to reflect that some of the best 
work in the wide world, especially in abdominal and intestinal 
.surgery, has been done by our friends, in our own-City of Chicago. 

103 State Street. 



THE PLEXUS 

THE OFFICIAL oKGAX:OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 
UNIVERSITY OF ILLINOIS. 

Editor, H. J. STEGEMANIV, '02. Business Mgr. G. G. DOWDALL, 'OO. 



Class Editors: 

F. C. BL.\CKW£LDER/OJ. W. O. AlcDO WELL, '0 1 . J. M. MEYERS, '02 



Faculty Department, Dr. W. A. I'asKV. Athletics, 

Alumni, Clinical Department, E. A. Gansel. 



Publishers. ----- DOWDALL & STEGEMANN. 

Subscription $1.00 per Annum in advance, swingle copies. 15 cents. Issued Monthly. 
Send all remittances and commaiiicatiuns as to subscriptions and advertising to G. G. 
DOWDALL, Business Manager, S13 W. Harrison St. 

Entered at Chicago Post Office as Second-Class Matter. 

Any subscriber desiring the .Journal discontinued at tlie expiration of his subscription! 
should so notify the Publishers: otherwise it will be assumed thai the subscription is to be 
continued and the Journal sent accordingly. 

Contributions of matter suitable for publication are invited, and slKuild be sent in not 
later than the25tli of the munth previous tothatof publication. The publishers willnot hold 
themselves responsible for the safe return of MSS, unless sutticieut stamps are forwarded 

EDITORIAL. 

The eighteenth annual course of instruction has opened 
under very auspicious circumstances. The number matriculated 
up to the present writing assures an attendance greater by far. 
than any previous year of the school existence. 

* * 

This issue of the Plexus will be the last issued under the- 
editorship of the present editor, who takes this means of thank- 
ing those who have so kindly contributed to the columns of the 
journal, those who have encouraged him by word or deed, and 
those who have so generously supported the Plexus by promptly 
paying into the coffers the necessary wherewith to conduct the 
journal. We heartily commend our successor, Mr. H. C. Waddle, 
to our readers, and bespeak for him your most hearty support. 

Long may ^^® PI.F.XUR continue to receive suclf support.. 



EilitoridJ 159 

May the good old P. & S. continue on the road to prosperity, and 
may the new editor receive as cordial support as it has been the 
.good fortune of the present one to receive. 



The following was clipped from the A/cdical Mirror of Sep- 
tember, 18'J4: 

"Of all the medical editors in America to-day, I consider Dr. 
Geo F. Butler, of Chicago, as one of the front rank men. He is 
a finished scholar, a high classed teacher, a successful, busy prac- 
titioner, an author of a superb book on Materia Medica, (which 
bears the evidence of being crystalized experience) a clear, con- 
cise, terse writer of good English, evideiitly a learned man, and 
yet with no suggestion of pedantry, and withal possessed of that 
quality so rarely found on the editorial Iripod, which can be best 
expressed as 'journalistic knack.' Our Editorial Guild Medical 
is to be congratulated in haiving Dr. Geo. F. Butler as a fellow."' 

Twas Dr. Butler who wrote the interesting matter j^rinted 
in the Clacago SiUKlay Tribune of September lOth, covering a page 
and a half, and devoted to the advances made in medicine during 
the nineteenth century. It was a masterly article, and proves 
that the above editorial is not too strong. Students of the P. & 
S. are fortunate in having such a valuable man as their teacher 
•of materia medica. 

DECEITFUL AND DISHONEST METHODS. 

The September number of the Gliicago Medical Recorder prints 
the following: 

"St. Luke's Hospital of Niles, Michigan, is a peculiar insti- 
tution, which offers certificates of membership upon its staff, 
beautifally engraved, of course, to i)hysicians for $5, with the 
understanding that they will be authorized to use the title of 
member of the staff. In addition, the alleged St. Luke's Hospital 
of Niles will write to a limited number of people to be named by 
the physician who pays ^5 for his certificate, after he has i^aid 
the i>5, urging them to employ the physician in question. The 
member of the staff is also authorized to send patients to the 
alleged St. Luke's Hos2:)ital of Niles, for which kindness he will 
receive a certain proportion of the amounts paid by patients so 
referred. This skin game has been in operation for some time, 
-and apparently there are many physicians willing to give up )?5. 



160 TRE PLEXUS. 

It is represented that such men as Nicholas Senn and others,, 
whose autograph lette^rs they publish, have accepted appoint- 
ments on this world-wide staff. It is a matter of regret that any 
member of the medical profession should be so easily gulled as 
seems to be the case, let alone the moral question involved." 

In the June issue of the Plexus will be found two letters 
written to a Chicago physician, in which the writer, a very illit- 
erate and uneducated man, mentions that he is " a visecting and 
consulting member, when called upon, of the St. Luke Hospital, 
Niles, Alich." 

The wonder is not so much that a man of his caliber could be 
persuaded to part with !t^o, which may possibly have been the 
case in this instance, as it is that men of prominence in the medi- 
cal profession can be found to sanction such unethical and im- 
moral practices. That such practices, and even worse, do take 
place is evident from the following, clipped from the Journal of 
the American Medical Association of Aug. ;^6th. . 

FOR SALE TO THE HIGHEST BIDDER' 

We can hardly believe that there are men in Chicago, who 
are willing to sacrifice their professional honor as is indicated in 
the letter printed below. Evidently there is one, but there cer- 
tainly can be no others. If there are, then of course, it is good 
business sense on the part of of those who have patients to sell, 
to sell them to the highest bidder. The letter was written to a 
well-known surgeon of Chicago, and as a similarly worded letter 
was sent to at least one other surgeon, by the same writer, it is 
probable that he will get the best terms that can be had. 

— , III , August 10, 1S90. 

Bear Doctor: — It so happens that I have occasion to refer 
operation cases to the city for treatment. I have been sending 
them to a gentlemen who has recently treated me in a way I 
don't like, and I am therefore desirous of making arrangements 
with some one else. What portion of the fee do you usually give 
the doctor who brings the case":* I am free to say I have always 
had 'jO per cent. This is not too much, because I always know 
ju.st what the patient can stand, and have him worked up for a 
good fee beforehand. This is a rich farming country, you know. 
An early answer will oblige, as I have several cases that ought 
to be operated on very soon. 

In an interview with a prominent, Chicago physician and 



Editorial. IGl 

sui'geon reg-ardino; questions of the ethical dishonesty, impro- 
priety, lack of professional dignity and esprit de corps opened" 
up by the foregoing letter, has very clearly and emphatically 
proved that such dishonorable practices should be condemned 
and that those who sanction such should find no favor within or 
without the profession. 

Said he: "Take the matter up from a purely business 
standpoint; what line of business, honestly conducted can pay 
50 per cent of its income for 'Coppers' y '' "Is it honest?" you ask. 
"I'll answer that question by propounding another. Is this in 
any wise different from a gambling game? Not much, only in 
this case the poor victim (the patient), stands to loose in either 
case." 

Temptations to unnecessary operations are hard to with- 
stand by unscupttlous physicians and no doubt if such cases were 
of frequent occurances many times patients would be persuaded 
to undergo operations for supjDOsed diseases merely that a 
scoundrel might obtain a fee. Such practices would be compar- 
atively easy to carry out if the general joractitioner had the 
moral (or immoral), support of the surgeon, who, in turn has the 
support of the general practicioner the patient with an inopera- 
ble disease is made the "bumping post."' 

Some body must be robbing some body else. Either the 
surgeon robs the patient or the general practitioner robs the 
surgeon. 

Such dishonorable means of securing patients should not 
and would not be sanctioned by any honorable surgeon, and the 
name of the doctor writing such a letter as that printed above, 
should be told and he should be ostracised from society of all 
kinds and so should the city surgeon who connives with such 
rascals. 

That the two instances pointed out are not the only 
methods employed, is proven by the following, also fi'om the 
Journal of the American Medical Association. 

STILL MORE COMMERCL\LISM. 

"In this column last week, under the caption "Per Sale to 
the Highest Bidder," we published a letter from a physician 
asking for bids for his patronage. We did not publish the 
doctor's name, although we believe we ought to have dotie so, as 



162 THE FLEXCS. 

it would then have given those surg-eons who give bribes for 
2)atients — if there are any — a chance to make a bid. 

Apropos of this kind of commercialism we have just received 
a letter from Dr. C. D. Wescott, Chicago, in which he says. 
••Enclosed I hand you a letter which I am sure will interest you. 
I know nothing of Dr. D., save that he is a homeopath living on 
the west side." Accompanying the above is a mimeograph 
circular letter supposed to have been written by the general 
manager of a mineral water company. The letter says: '"It 
has been suggested that we make a special proposition to 
prominent medical men, something like this: We pay you fifty 
•cents per case for all orders received through your aid. The 
average number of cases now being used by the patients is 
about ten each: consequently you will observe, it will not 
require many customers to largely increase your revenue. 
Please advise us at your earliest convenience if this proposition 
interests you. You can easily send us names of people to whom 
we will send circulars, and if you like, we will attach a slip 
saying: 'Show this circular to your physician, and ask his 
opinion of the analysis of this natural water." That will give 
you an opportunity to both recommend and endorse the water to 
mutual benefit. '" 

''P. S. — Dr. T. C. D , of Chicago, mentioned your name 

favorably to us."" 

Note what a smooth game they propose to work by the 
"slip:"" "Show the circular to your physician and ask his 
opinion on the analysis of this natural water."" The question 
arises: Can such an outrageous insult to honesty aiid intelli- 
gence be met as it ought to be'r' It is a species of bribery, and a 
low species at that. 

In the same mail came the following: 

Pemberville, Ohio, Aug. l^^, 1H99. 

"I enclose herewith a letter and folder which I have just 
received and which are self-explanatory. You may well believe 
I was thoroughly disgusted with their contents and the liberal 
'i:)roposition" made by this 'hereditary" specialist. 

"Believing that it is the duty of self-respecting physicians 
to expose these 'bleeders" whenever they make these proposi- 
tions, I forward these to you at once with the request that you 
make public in your esteemed Journal the liberality of this great 



Editor!al. 163 

reformer of 'explode" theories. I wish to exj^ress my appre- 
ciation and emphatic endorsement of the warfare or rather 
crusade which you are makino; against this class of persons. 
I trust you will favor me by lending your great influence against 
this man. 

L. P. H. Bahrenberg, M. D. 

Following is a copy of the letter sent to Dr. Bahrenberg: 

"Dear Dcctof: — I realize that the treating of cancer patients 
is very disagreeable to many physicians, and thinking that you 
might be one of the many who do not care to treat cancer pa- 
tients, I tal^e the liberty to write you and make you a proi^osi- 
tion: 

' 'Any person afficted with cancer who may call on you for 
treatment, if you will bring or direct them to my sanitarium, I 
will give you 10 per cent, of the money I receive for treating 
each patient you may send to me. 

"My charges for treating and curing a cancer are from 50 to 
250 dollars. Kindly let me hear from you." 

Circulars, and "pictures" tell what wonders are being done 
by this miracle- worker. '-My father and grandfather cured can- 
cer when I was an infant," he tells* us, and for this reason, as the 
circular says elsew^here, he is, "by inheritance, by intuition, by 
study, and by a broad and varied experience, thoroughly quali- 
fied to practice my specialty — treating and curing all forms of 
cancer." 

Letters or circulars will confer a favor upon suffering human- 
ity and the profession by giving wide publicity to such commu- 
nications. 

It is to be hoped that few can be found who will accept such 
schemes and make use of such unscrupulous methods to acquire 
a "few dollars.'' 



A CLINICAL REPORT OF FOUR CASES OF 
ABDOMINAL SECTION. 

By S. H. Champlin, M. D. 

Instructor in Surg-evy, N. W. W. M. College : Member Advisory Statf, Cook 
County Hospital : Member Quizz Staff, P. >-^ S, 

These cases are reported, not so much to demonstrate surgi- 
cal results, or on account of tneir infrequency, but for their value 
to the statistician. 

Case I. While not properly belonging to the series of the 
other three, is published with them on account of the resemblance 
of the conditions found to those found in cases III and IV. 

These patients were operated upon at the Cook County Hos- 
pital — the first two by Dr. Chas. Rowan, of the house staff, and 
myself, with the assistance of Dr. Thompson, also of the house 
staff; the last two by Drs. Bench, Lewis and myself. 

Bacteriologic examination was made in No. II by Dr. Wells, 
of the resident medical stafi, but no examinations were made in 
the other cases. Differential culture tests demonstrated typhoid 
bacilli, colon bacilli and several varieties of micrococci. 

Case I. B. S., Russian, female, age 16 yrs., single, nurse 
girl. Admitted to hospital 7-!^5-'99 at 9:30 P. M., giving history 
of having been taken sick suddenly two days before with diffuse 
abdominal pain, vomiting, diarrhoea and loss of appetite. Pa- 
tient commenced to menstruate two days before attack. 

Examination: Tongue shows thick wh,ite coating, back 
and buttocks covered with large scar of burn, received some 
months previous; heart and lungs negative; marked abdominal, 
pain and tenderness, slight tymjiany, dullness in dependent parts, 
area of dullness changing with change of position of jDatient; 
recti muscles fixed and stiff, the right being somewhat less yield- 
ing than left; under aucesthesia a movable tumor felt at McBur- 
ney's point. Vaginal examination shows hymen intact. Tem- 
perature 102*, pulse 124, resp. 28. 

Operation: Abdomen and pubes shaved and scrubbed suc- 
cessively with soap and water, sterile water, alcohol, ether, 5 
per cent, carbolic and I-IO;).') bichloride. Incision over tumor. 
On opening the peritoneum there was an escape of a considerable 




S. H. CHAMPLIN, M. I). 

Instructor in Sur°:ery, N. W. W. M. College; Member Advisory Staff. 

Cook County Hospital ; Member Quizz Staff, P. & S. 



Clinical Report — ( li(iiiiplin. 165 

quantity of turbid, greenish, foul- smelling fluid, containing flakes 
of fibrin. The intestines were highly injected, being a dark pur- 
plish red in color, but still retaining the natural gloss of the 
normal peritoneum. The appendix was completely surrounded 
by omentum, almost to its base, and the mass thus formed — 
about as large as the index finger — was freely movable. When 
the omentum was stripped off, two fecal concretions were found 
protruding from an opening in the appendix, but prevented from 
coming entirely out by the close adherence of the omentum. 

The appendix and adherent omentum were tied and cut a way; 
the abdominal cavity was flushed with a large quantity of warm, 
normal salt solution. A counter opening was made over the 
crest of the ilium, and a large drainage tube left in, an end pro- 
truding from each wound. Strips of iodoform gauze were packed 
about the Ctccum, completely surrounding the stump of the 
appendix, the free ends of the gauze protruding from the original 
wound. The greater portion of the incision was then closed with 
silk-worm gut sutures. 

Twenty-four hours after operation patient's temperature lOU*', 
pulse 120. There had been some vomiting and catheterization 
was necessary. Thirty-six hours after operation a large liquid 
bowel movement was obtained by use of hourly doses of magne- 
sium sulphate, of 5ii each. 

Recovery was uneventful with the exception of a small fecal 
fistula, which persisted for a few days only. 

Case II. A. O., German, -age 10, male. Patient had run the 
course of a typical typhoid of five weeks' duration, the last three 
weeks in Ward 4, Cook County Hospital. His temperature had 
been normal for thirty hours, when on the morning of August 
16th, at 7 o'clock, he had chill lasting thirty minutes, vomited, 
complained of great abdominal pain, cold perspiration, eyes 
sunken and knees drawn up; temperature subnormal, pulse 120. 
At VI o'clock noon of the same day, his temperature was 104- and 
pulse 120. From this time until Aug. 19th, 1899, when he 
was transferred to the surgical ward, pulse and temperature was 
irregular, pain and tenderness continued and patient refused 
food. On August 19th examination revealed an emaciated boy, 
with anxious expression and somewhat stupid. The abdomen 
was rigid and somewhat distended and very tender. Extending 
from a point a little below the anterior superior spinous j^rocess 
of the ilium, on the right side, and passing diagonally across the 



166 THE PLEXUS. 

abdomen to a point over the crest of the left ilium, was an area 
of dullness that did not change with a change of posture in the 
patient. 

Patient wasanassthetized, made surgically clean, as in case I, 
and an incision made over the most prominent point of the tume- 
faction. The fluid that escaped was turbid, greenish and of fecal 
odor, containing light greenish colored flakes of fibrin, and the 
lower stratum being semi -liquid and containing a great many pus 
cells. A digital examination of the cavity showed it to follow 
the same general lines of the external examination. Passing 
through the cavity from the promontory of the sacrum to the 
fundus of the bladder, was a band as large as the finger, appar- 
ently of indurated omentum. It was not disturbed. The peri- 
toneal adhesions had made a complete barrier between the cavity 
and the general peritoneum. Drainage consisting of a rubber 
tube surrounnded by iodoform gauze was inserted and wound par- 
tially closed with silk- worm gut sutures. Recovery. 

Case III. F. B., Bohemian, male, age ;22, laborer, sick 
fourteen days with typhoid. Late in afternoon of September 6th, 
1899, patient was suddenly seized with sharp abdominal pain and 
chilly sensations, with other symptoms of perforation. Dr. J. 
M. Neff, of the resident medical staft", diagnosed intestinal per- 
foration, and had patient transferred to surgical ward. 

Patienfs expression was anxious, eyes sunken, skin covered 
with cold perspiration, thighs flexed on abdomen, abdominal mus- 
cles rigid, some superincumbent tympany, and patienfs expres- 
sion gave evidence of great tenderness and pain; dullness in 
dependent i3arts of abdomen, changing with position of patient. 

After usual preparation a median incision was made. The 
fluid contained in the abdomen was similar, in all respects, to 
that of the foregoing cases. The intestines were purplish- red in 
color; veins in om^-ntum and intestines greatly injected: Y>evi- 
toneal covering glossy. Perforation, covered by omentum found 
about 30 cm. from ileo-ceecal valve in ileum. Perforation was 
closed first with transverse continuous suture; a longitudinal fold 
was then made in the intestine and the transverse suture was 
completely buried by a row along the longitudinal fold. To fin- 
ish, the omentum was brought down and stitched over the whole. 
Toilet of peritoneum and drainage was carried out as in Case I. 

Patient was in poor condition when placed on operating 
table, but reacted nicely after operation. Twenty-four hours af- 



(li)iic(il Ripovt — <_^1i(im})l ill. 167 

ter, a free, liquid bowel movement was obtained. Vomiting and 
cough was quite persistent. Patient died on third day after ope- 
ration- A few hours before death oedema was noticed along 
right side of abdomen and chest, together with lymphadenitis of 
the axilliary glands. 

Dr. Ludvig Hektoen posted the body and the points of inter- 
est, noted, are as follows : 

[a) Intestinal closure practically unchanged. 

(b) Peritonitis, principally contined to pelvis and about per- 

foration. 

{(-■) Small amount of turbid fluid in abdominal cavity. 

((/) Purulent, infiltration of the right side of abdomen and 
chest, commencing at upper right angle of wound and 
extending to right axilla. 

[e) Hypostatic congestion of lungs. 

(/) No obstruction in bowel. This had caused some di.cus- 
sion at time of operation on account of the double fold in the 
thickened wall of the intestine. At the post-mortem a free pas- 
sage was seen to persist — the longitudinal inversion showing as 
a smooth ridge on the mucous surface. A bacteriological exam- 
ination and culture of the pus, infiltrating the muscles, proved it 
to be due to streptococci. 

Case IV- A. H., male, U. S. A*., occupation barkeeper aud 
electrician. Had run an irregular temperatui'e and pulse for one 
month previous to operation. Diarrh(x^a for two weeks, wich 
varying pains and tenesums. Appetite very poor — no vomiting. 
Slight jaundice several times; considerable loss of weight; con- 
stant abdominal pain since sickness began; restless; no nose- 
bleed; no blood in stools; drank beer and lived on eggs and milk 
since sickness began. Admitted to hospital September .", 1<^99. 
September sth, Dr. Rowan called me to examine patient. AVe 
found him in great pain, moaning and rolling from one side of 
the bed to the other; eyes sunken; cold perspiration; extremities 
cool; thighs flexed on abdomen, and dullness in dependent por- 
tions of abdomen; recti rigid; pain and tenderness, and more 
marked at McBurney's point; pulse, 120; temperature, lOS*^; pulse 
very w^ea':<. 

Operative treatment carried out as in Case III. Perforation 
20 cm. from ileo-csecal valve. During operation patient received 
hypodermics of strychnia, whiskey and aromatic spirits of am- 



168 HIE PLEXUS. 

monia, tog-ether with normal salt solution, intravenously; but he 
did not react and died ten hours later. No post-mortem allowed, 
The post operative treatment in the cases consisted of 
strychnia hypodermicallj"; enemas of coffee, whiskey and salt 
solution; morphine given as often as necessary in first twelve 
hours: magnesium sulphate 5ii was given every hour until bowels 
moved, or if the stomach would not retain magnesium, calomel 
was g-iven in quarter-grain doses every hour. 



OPENING EXERCISES. 

The opening exercises of the Eighteenth annual course of in- 
struction of the College of Physicians and Surgeons were held in 
ill the college amphitheatre Tuesday evening, Sept. 19th. Mem- 
bers of the faculty, students and friends, accompanied by their 
wives and sweethearts, enjoyed a very pleasant evening. After 
the rendering of the following program refreshments were 
served in the disj^ensary and adjoining rooms, after which danc- 
ng was indulged in until the striking of the midnight bell an 
nounced the coming of a new^ day. 

PROGRAM OF OPENING EXERCISES. 

Selection P. and S. Ma,ndolin Club 

Prayer 

Vocal Solo Miss Carter 

Selection America Quartet, Tenor, F. A. Meyenschein; 2nd 

Tenor, C. Van Dame; Baritone, Fred Maas; 

Base, A. B. Bradish. 

Opening Address Dr. Frank B. Earle 

Vocal Solo Miss Carter 

Selection America Quartet- 
Timely Remarks Dr. Wm. E. Quine, Dean. 

Selection P. and S. Mandolin Club 

HOW TO KEEP BUSY. 

There was once a firm that never advertised but were always 
busy. They had a Waterbury watch and the itch. When they 
v^ere not winding the watch they were busy scratching. 

Advertisers in the Plexus have neither but are kept busy 
filling orders. 

Moral: Advertise in the Plexus. 



THE PASSING OF DR. SPARROW. 

It has rarely been my fortune to meet so modest a man as 
young- Dr. Sparrow. His modesty was of that inflammatory type 
which, under conditions of strong excitement, mounts to one's 
brain in a surging, pulsing flood, and washes out any stray ideas 
that may be playing hide and seek in the nooks and crannies of 
the mind. While at college, our young friend was continually 
tumbling over himself, metaphorically speaking, in the recita- 
tions and quizzes given by the professors. 

Having the honor of being one of his teachers, I often had 
occasion to note with some commiseration the young man's con- 
fusion at such times. But Sparrow was a hard, earnest worker 
and as bright as a dollar, and the members of the faculty were 
very indulgent to his infirmity. I recall, however, that we were 
wont to speculate on his chances of success in the practice of 
medicine, a profession in which modesty must ever be tempered 
with self-confidence and an abundance of nerve. 

Sparrow graduated in due time, and with honor, — he couldn't 
very well stammer on paper — and his teachers made due allow- 
ance for his bashfulness when he mixed up his answers in the 
green-room quiz. 

Soon after graduation Dr. Sparrow cast about for a suitable 
location, and with his characteristic lack of assurance, finally 

selected the town of B , a little hamlet in Northwestern Iowa. 

B had gotten on pretty well without a doctor for some 

months, the medical patriarch of the town having finally suc- 
cumbed to the combined effects of old age, exposure, and a vain 
attempt to keep up his nutrition with the oats and potatoes given 
him in lieu of fees. 

But the towns-people were nothing if not fashionable, and 
they straightway proceeded to develop a quinine and blue mass 
• cult that bade fair to speedily put the young doctor on the road 
to affluence. 

Dr. Sparrow's reputation spread rapidly, and to use a politi- 
cal expression, he soon had the entire county in his pocket. But 
fate was pursuing our young friend, and in due time cut down 



170 THI-: PLEXUS. 

the budding flower of his professional ambition by a blow from 
an entirely unexpected quarter. 

Like all country towns, B was poorly supplied with 

means of diversion and entertainment. As saloons were not per- 
mitted, the citizens were compelled to resort to religion as a 
source of recreation and excitement. At periodical intervals the 
good people suffered from attacks of religious fervor in an acute 
form; at such times revivals were in order, and constituted the 
principal industry of the town. 

During one of these revivals, the itinerant clergyman who 
was conducting the affair called upon Dr. Sparrow for the pur- 
pose of interesting him in the religious movement that was then 
absorbing the attention of his fellow-townsmen. After introduc- 
ing himself to the doctor the dominie said: 

"You are well aware, my dear doctor, that, as the physician 
of this beautiful town, you are considered one of its most repre- 
sentative citizens. The ph^^sician more than all other men in a 
community is in a position to guide his fellow-citizens both by 
precept and example. Knowing this, I have come to you for the 
purpose of enlisting your sympathies, nay, your active co opera- 
tion, in the wonderfully successful revival we are now having. 
In furtherance of this object I should be extremely pleased to 
have you with us this evening." 

Dr. Sparrow knew the temper of his clientele pretty well, and 
was by no means desirous of locking horns with the preacher. 
He was a bit of a free-thinker in his way, but was not very well 
posted in church etiquette, so he resolved to run no risks of being- 
boycotted by his fellow-townsmen. "Why," he said, "I'm a 
trifle rusty in such matters — always busy with my practice, you 
know, but if my presence will be of service to your show — er 

. no, I mean revival, I should be glad to drop in for a few 

moments."' 

' ' I assure you, doctor, that you will greatly help the good 
cause along by being with us," saying which the reverend gen- 
tleman departed. 

The revival meeting had just opened up when Dr. Sparrow 
arrived. The preacher was concluding his opening prayer. As 
he rose and looked over the audience, he spied the doctor, who 
had sneaked modestly into one of the rear pews. With a grati- 
fied smirk, he said: 

"Brethren, we are most highly honored to-night by the 



Dr. Sparroyj. 171 

presence of one whom you all know and respect; a man whose 
profession is such that he must necessarily come closer to your 
hea>rts than other men, a man whose learning and skill have done 
much for this community. The grace of God has so touched our 
dear friend that he has resolved, at great inconvenience, to be 
with us, and lend us his aid and counsel ia our conferences with 
God and our struggles with Satan. I will ask our dear friend. 
Dr. Sparrow, to lead us in singing a hymn, after which I am sure 
he will kindly favor us by leading in prayer." 

Now, Dr. Sparrow had not seen the inside of a church, save 
when he attended the funeral of some luckless patient or other, 
for many years. His stock of hymns was never very plentiful, 
and just at that moment was a negative quantity. As for pray- 
ing, he had lost all his talent in that direction — if he ever had 
any. To make matters worse he was so overcome by his old 
time modesty and trepidation that he could hardly speak at all, 
to say nothing of vocalizing. But he realized that something- 
must be done, and he rose to his feet, feeling quite as comforta- 
ble as a man about to be executed, meanwhile cudgeling his brain 
in the effort to tear out a verse of a hj'mn. 

"W — w — why, my b — b — brethren, th — th — this is too — too 
much honor. I'm n — n — no singer, and the rev- reverend doctor 
can p — p — pray b — better than I can." 

Just then a gleam of light illumined the particularly dark 
corner of his brain in which were stored his early religious im- 
pressions, and he said, "B — b — but I'll do m — m — my best. We 
will s— s — s — sing that b — b — beautiful hymn, 'The G — G — Great 
Physician N — N — Now Is Near.' " 

Like most modest men. Dr. Sparrow endeavored to cover up 
his confusion by throwing a liberal allowance of counterfeit 
enthusiasm into the work in hand, and therefore did the hymn, 
the fullest possible justice. The congregation struggled as best 
it could to make itself heard, but the doctor's voice was so pain- 
fully in evidence that his singing closely approximated a solo. 

The hymn being concluded, the doctor's agony had but just 
begun — he was noAV asked to lead in prayer. Heart failure was 
imminent when, fortunately, he was hurriedly called to attend 
an important case. With a sigh of relief he grabbed his hat and 
fairly ran out of the church. 

A week later Dr. Sparrow attended a meeting of the county 
medical society, and was surprised to find himself decidedly un- 



172 THE FLEXUS. 

popular with the other members. The treatment he received at 
their hands was coldly contemptuous, and very trying to one so 
sensitive as our young doctor. But the worst was yet to come. 
An ethical old member with long, seedy, tobacco- stained whisk- 
ers, arose and preferred charges against Dr. Sparrow, who, he 
said, had violated the ethics of the American Medical Association 
by advertising. A committee was appointed to investigate the 
charges, and the meeting adjourned without affording the embar- 
rassed young man an opportunity either to ask or offer an expla 
nation. 

The investigating committee faithfully performed its duties, 
and after ascertaining the circumstances attendant upon Dr. 
Sparrow's performance at the revival meeting, formulated a 
report by no means complimentary to him. Some of the lay 
brethren seemed to think that young Sparrow's dereliction was 
satirical, and that he had endeavored to burlesque the revival. 
This was seriously considered by the members of the commit iee, 
but on learning that the doctor had afterward been ca'led out of 
church, they winked significantly at each other and said: 

"Um — ah!" meanwhile recalling the tricks of their own early 
days. This settled the doctor's fate. 

The old moss-backs promj)tly made their report, which was 
to the effect that '"We, the committee, find that Dr. Sparrow has 
flagrantly violated the code of ethics by advertising, and we 
recommend that he be expelled from this society." 

The recommendation of the committee was followed and the 
doctor expelled. 

Dr. Sparrow's professional occupation being gone, he was 

compelled to shake the dust of B from his sandals and seek 

for pastures new. He is now traveling for a manufacturing drug 
house, and it is needless to say, is cured of his modesty. '-Drum- 
ming for trade," he says, '"is not so glorious an occupation as 
chasing fifty-cent fees on muddy country roads in the early 
spring, but for comfort it is far ahead of the practice of a ' liberal 
profession."'" 



CLINICAL LABORATORY DEPARTMENT. 

W. E. CoATES, M. D. 
GLinica I Laboratory Ann ouncem ent. 

I. The Clinical and Research Laboratory of the College of 
Physicians and Surgeons has been established to utilize the path- 
ological material obtained from the College Clinics as an aid to 
clinical teaching, and to encourage advanced and original studies 
in laboratory medicine. 

II. Professors and Instructors of the Laboratory Faculty of 
the College will co-operate and advise in the work of the Clinical 
Laboratory as follows: 

Dr. W. E. Coates, Director of the Clinical Laboratory. 
Prof. W. A. Evans, General Pathology. 
Adj. Prof. C. C. O'Byrne, General Pathology. 
Dr. Theo. Tieken, General Pathology. 
Prof. Carl Beck, Surgical Pathology. 
Dr. D. N. Eisendrath, Surgical Pathology. . 
Prof. Adolph Gehrmann, Bacteridlogy. 
Prof. E. G. Earle, Histology. 
Adj. Prof. E. C. Seufert, Histology. 
Prof, J. A. Wesener, Physiological Chemistry. 
Prof. F. E. Wynekoop, Biology and Embryology. 
Dr. Ira Wynekoop, Biology and Embryology. 
Prof. M. L. Goodkind, Clinical Diagnosis. 
III. The work of the Clinical Laboratory will be arranged 
in optional courses of study according to the following schedule: 

1. Clinical Microscopy and Urinalysis. — The examination of 
urine, sputum, pus, blood, etc., obtained from the dispensary 
clinics. 

2. Surgical Pathology and Bacteriology. — Open, by appoint 
ment of the Clinical Laboratory Director, to a limited number of 
students, each of whom will be assigned to one of the regular 
surgical or medical clinics. Students so appointed will be held 
responsible for the pathological work of the clinics to which they 
are assigned. 

3. General Pathology and Pathological Anatomy, — This 
course will include the gross and microscopical study of mu,seum 



174 THE PLEXrS. 

and fresh specimens of tissue obtained from jjost-morteir ex:amina- 
tions. Special efforts will be made to combine a careful study of 
the clinical history of each case with the study of the gross and 
microscopic changes. 

4. Advanced and Research Work in General Pathology. — 
Oj^en to a limited number of specially qualified students. Stu- 
dents selecting this course will be required to engage in research 
work on the diseases, or some special disease, of some one organ 
of the body, such as the kidney, liver, spleen, etc. 

5. Advanced and Research Work in Surgical Pathology. — 
Open to a limited number of students, who will engage in research 
on some particular surgical disease such as epithelioma, sarcoma, 
tumors of the mammary glands, etc. 

6. Advanced and Research Bacteriology. — A course in ad- 
vanced bacteriology and bacteriological investigations of certain 
diseases of man and animals. 

7. Advanced and Research Work in Histology, Biology, or 
Embryology. — Open to students who desire to carry on further 
study in any one of these subjects. 

8. Physiological Chemistry. — An advanced study in the 
physiological chemistry of the urine, gastric juice, etc. 

IV. The Clinical Laboratory is designed especially for 
students of the Junior and Senior years, but Freshmen or Sopho- 
more students qualified to undertake advanced work can be 
accommodated. 

V. The hours of work in the Clinical Laboratory may be 
arranged to suit the time at the disposal of the students, but 
sufficient time must be given to any course selected to properly 
carry out the work undertaken. 

VI. Students availing t]iemselves of the privileges offered 
in the Clinical Laboratory will be under the immediate dii-ection 
of the director of the laboratory, who will assign desks; issue 
material for work, and exercise a general supervision over the 
students' work. Failure to properly carry out work undertaken, 
either through lack of time or lack of attention to the work, dis- 
orderly or improper conduct in the laboratory, Avill constitute a 
just cause for withholding the privileges of the laboratory, at the 
option of the director. 

VII. The main object of the Clinical Laboratory being to 
encourage advanced and original work, students deficient in their 
regular laV)oratory courses, or who have failed in such courses, 
will be required to make up such deficiency before selecting any 
of the ox)tional courses. 



LIBRARY NOTES. 
Grace W. Bryant, Librarian. 

For the benefit of the new students entering the P. & S., the 
following facts about the library may prove of interest. The 
Quine Library is situated on the second floor of the college build- 
ing, and is open daily from 9 A.M. to .") P. M. , with the excep- 
tion of Saturday, wiien it closes at noon. It is a reference lib- 
rary, numbering betw^een three and four thousand volumes, 
including the latest text-books, files of medical journals, and the 
leading indexes. The current medical journals are also on file. 

The library is free to all, and is in charge of a trained libra- 
rian, who is ready to assist the students in the use of the card 
catalogue and indexes, and also to make reference lists from ma- 
terial in the library on any desired subject. 

During the summer two very much needed improvements 
have been made in the library. A case has been built for the 
current journals, and the reading-room has been enlarged to 
accommodate the increased number of readers. 

Dr. W. T. Eckley did not forget the library when his "Prac- 
tical Anatomy" was published, but 'had a copy sent us, which 
favor we highly appreciate. 

We are indebted to the publishers Lea Bros. & Co. for hand- 
some editions of Jewett's "Practice of Obstetrius by American 
Authors," and Gerrish's "Text-book of Anatomy by American 
Authors." 

Hon. Chas. Truax, of Truax, Greene & Co., has sent us with 
his compliments an autograph copy of his "Mechanics of Sur- 
gery:" quoting the Chicago Med. Recorder, "Mr. Truax is entitled 
to the gratitude of the surgical profession for the completion of 
this most masterly treatise on the subject of the 'Mechanics of 
Surgery.' The attempt is to raise a catalogue above the level of 
the ordinary price list, and to furnish reliable and explicit inform- 
ation on the subject of medical and surgical instruments and 
appliances." 

We have noted the following articles by members of our 
Faculty, in the medical journals coming to the library, during 
the last two months: 



17G THE PLEXUS. 

Dr. W. L. Ballenger, "Case of Middle Ear Disease,"" Jowr. 
A. M. A., Aug. 12, 1899, p. 399-400. 

Dr. G. F. Butler, "Medical Progress — Preventive Medicine," 
Medical Mirror, Sept. 1899, p. 431^-81; "Therapeutics, Past, 
Present and Future,"" Indiana Med. Jour., Sept. 1899, p. 118-19t 
"The Lj^nching of the City Marshal,"" (from Carters Monthly for 
June) Medical Mirror, Aug. 1899, p. 413. 

Dr. H. T Bj^ford, "Intestinal Treatment of Tuberculous Peri- 
tonitis,"" Jour. A. M. A., Sept. 1899, p. 641-43. 

Dr. F. B. Earle, "Diagnosis and Clinical Course of Puerperal 
Eclampsia,"" Med. Standard, Sept , -p. 391. 

Dr. L. H. Mettler, "Medicinal Treatment of Nervous Dis- 
eases MercJc's Archives. Aug. 1899, p. 332-36. 

Dr. G. F. Lydston, "Athletics in their Relation to the Male 
Genito-Urinary Organs,"" Medical Mirror, Sept. 1899, p. 432-34. 

Dr. E. C. Seufert, Forty-three Cases of Typhoid Fever, with 
No Deaths, and with Complications in but One Case," New York 
Med. Jour., Aug. 12^ 1899, p. 233-36. 



NEW BOOKS. 

Allis, O. H. — Inquiry into the difficulties encountered in the 
reduction of dislocations of the hip (Sam"l D. Gross prize essay) 
1896. Dr. O. H. Allis, donor. 

Boissier de Sarwages, Francais. — Nasalogie Methodique, 
1771. Dr. E. C. Winans, donor. 

Boston City Hospital. — 33rd report, 1897. M. Frank, donor. 

Eckley, W. T. & Eckley C. B.— Practical Anatomy, 1899. Dr. 
W. T. Eckley, donor. 

Gerrish, F. H., ed. — Text-book of anatomy by Amer. authors, 
1H99. Lea. Bros. & Co., donor. 

Jewett, Chas., ed. — Practice of obstetrics by Amer. authors, 
1S99. Lea Bros. & Co., donor. 

Lind, M.— Traite de scarbut, V. 2, 1771. Dr. E. C. Winans, 
donor. 

Louisiana State Med. Society. — Transactions, V 19, 1899. 
Society, donor. 

Ohio Hospital for Epileptics.— Bulletin, 1899. Dr. A. P. 
Ohlmacher, donor. 

New York, Health Board of. — Annual report, 2 V. V. 18, 
189H. Board, donor. 

Pennsylvania Hospital. — Report, 1898. M. Frank, donor. 



Xofis. 177 

Petit, J. L.— Maladies des os. 1741, 2 V. Dr. E. C. Winans, 
donor. 

U. S. Marine Hospital. — Annual report of Supervising Sur- 
geon-Gen. V. "27, 1H99. Gov't., donor. 

U. S. Surgeon Gen. Office. — Index catalogue of library of 
Surgeon- Gen. Office. Ser. 2, V. 4, D-Emulsion, 1899. 



ALUMNI NOTES. 

The class secretaries have taken up their work in a very 
commendable spirit. The general secretary is already feeling 
the results of their labors. Letters are coming in from unex- 
pected quarters. EveryM^here there is greater indication of life 
in alumni matters. 

In the olden days the college estimated that the total student 
body would be double the number of matriculants by the opening 
night. 

The Alumni will remember Dr. S. Stoltz writes us of the 
death of Dr. A. C. Shedler of South Bend, Ind., on Aug. 10th, 
1899. The Doctor passed away at the home of his father at 
Lakeville. He died of Addison's Disease. Dr.C. E. Hansell, '98, 
Lakeville, and Dr. Stoltz were in attendance. 

93. T. M, Stixmed, Worth wood, Iowa. 

'93. Dr. F. M. Archibald, Atwater, Minnesota. Dr. Archi- 
bald, as happy and jolly as of old, favored us with several visits 
during his stay at the Clinical School. 

'93. Drs. O. F. and Christian A. Hegge, Austin, Minn. 

'93. J. H. Martin, Centerville, Minn. 

'93. F. J. E. Ehrman, 932 W. 22d St., Chicago. 

'93. G. N. Hibbert, 29th and Wallace Sts., Chicago. 

'93. C. Boddiger, Archer and Main Sts., Chicago. 

'93. F. L. Abe, Halsted and 80th St., Chicago. 

'93. W. A. Smiley, Rennville, Minn. 

'93. G. E. Chamberlain, Waterville, Minn. 

'93. J. S. Killbrid, Sleepy Eye, Minn. 

'93. M. L. Allen, Tama, Iowa. 

'93- Dr. S. J. Boyd, 103 State St., Chicago. Dr. Boyd is 
Prof, of Therapeutics in Illinois Medical College. 

'93. Richard Fyffe, 86 S. Robey St., Chicago. 

'93. Chester A. Brink, Ord, Nebraska. 

'93. Neal Cameron, Burwell, Loup Co. , Nebraska. 



178 THE PLEXUS. 

•93. Henry H. Clark, White, S. D. 

'93. Dr. Arnold, Hecla, S. D. 

"93. W. F. Fee, Meade, Kan. 

■93. P. C. Madison, 866 W. Van Buren St., Chicago. 

■93. J. J. Pierson, 353 oth Ave.; Chicago. 

'93. C. C. Feurtermacher, Jones, Mich. 

•93. O. W. Roff, Newton, Kan. 

'93. Chas. Stoltz, South Bend, Ind. 

■93. Jas. L. Stewart, Irene, S. D. 

■93. E C. Seufert, 8l'9 Milwaukee Ave., Chicago. 

■94. W. D. Dil worth, Huenenie, Cal. 

•94. D. W. Evans, Dell Rapids, S. D. 

•94. W. A. Kuflewski, 7iM W. 180th St., Chicago. Dr. Ku- 
flewski has recently been appointed a member of the Library 
Board of this city. 

'94. Chas. C. O'Byrne is filling the position of secretary to 
the college during Dr. Pusey's absence, His efficiency is attested 
by the large size of the present student body. 

■94. A. M. Osness, Dayton, Ohio. The in'Ogramme of the 
forthcoming meeting of the Mississippi Valley Medical Society 
offers a paper by Dr. Osness. 

■94. E. A. Planck, Union, Mich. 

'94. Thad. L. Round, Tampico, 111. 

'94. H. W. Smith, Roodhouse, 111. 

•94. C. H. Wilder, ::eKalb, 111. 

■94, W. D. Stevens, Paw Paw, 111. 

'94. H. S. Stevens, Flavis, Iowa. 

'94. J. A. Wesener, 103 State St. Chicago. 

■94. Dr. S. Stevens, Dowagiac, Mich. Dr. Stevens was at 
the college recently, bringing a patient to the clixiic. 

■94, H. M. Richter, (55r)9 Cottage Grove Ave., Chicago. Dr. 
Richter is a lecturer in Northwestern Medical school. 

•94. U. G. Windall, 30") Park Ave., Chicago. 

■94. F. C. Richmond, Arcadia, Wis. 

•94. A. E. Lauson, 848 Marshall St., Milwaukee, Wis. 

'94. Henry Hartung, 596 Sheffield Ave., Chicago. 

•95. H. H. Ainsworth, 433 Flournoy St., Chicago. 

■95. B. E. McShane, Hales Corners, Wis. 

'95. Lee Weber, Davenport, Iowa. 

■95. W. J. Cochrane, Quincy, 111. 

•95. E. T. Talbot, Brooklyn, Iowa. 



Ahnniil. 1'9 

'95. E. S. Day, Earlham, Iowa. 

'9.'). A. F. Lemke, 100 State St,, Chicago. Dr. Lemke is to 
give third year practice this year in place of Dr. Post, absent on 
leave of absence. Dr. Lemke is also to give bedside instruction 
to the senior class in the wards of Cook County Hospital. 

'9r). Dr. Joseph Beck is in Prague doing work in Pathology 
with Chiari. 

'95. Dr. Victor Meltzer ll^ilnd St., between Madison and 
Park Ave., New York City. 

'95. S. H. Champlin, lOOi W. Madison St., Chicago. 

'95. F. F. Seville, Monroe and Homan Sts., Chicago. 

'95. B. Filbenstein, Milwaukee and California Aves. Chicago- 

'95. C. W. Dulin, Rialto Building, Kansas City, Mo. 

'95. E. T. Talbert, Flandean, S. D. 

'95. Arthur Goebler, 1906 W. 51st St., Chicago. 

'95. T. J. Heckman, Hinckley, HI. 

'95. G. W. Johnson, 733 Grace St., Chicago. Dr. Johnson 
has recently left the institution at Dunning after several years" 
most efficient service. He has married and engaged in private 
practice. 

'95. C. H. Leduc, Danbury, Iowa. 

'95 Earl Rice, Roland, Iowa. 

'95. Dr. R. E. Steele, Salt Lake City, Utah. Dr. Steele has 
been attending the clinical school. * 

'95. C. L. Lenard, 467 Milwaukee Ave., Chicago. 

'95. S. B. Clark, Buffalo, N. D. 

'95. M. F. Doty, 5 Blue Island Ave., Chicago. 

'95. G. D. B. Dods, 1560 Jackson Boul'd., Chicago. 

'95. Dr. F. S. Diller, Roberts, 111. 

"95. Dr. A. Swartz, 13th and Blue Island Ave., Chicago. 

'95. J. V. Lewis, Momence, 111. 

'96. L. W. Schawb, 449 41st St., Chicago. 

'96. S. B. Seagley, Humboldt, 111. 

'96. I. J. Strauss, 3640 Cottage Grove Ave., Chicago. 

'96. A. A. Starner, Mt. Hope, Ohio. 

'96. A. H. Linaweaver, Findlay, Ohio. 

'96. Jesse McClain, Costrocton, Ohio. 

'96. G. W. Gill, Lorain, Ohio. 

'96. C. A. Yates, Bangor, Wis. 

'96. C. A. L. Bradfield, LaCrosse, Wis. Dr. Bradfield sends 
as several reprints. 



180 THE PLEXUS. 

*96. F. C. Zapffe, 9iVi Warren Ave., Chicago. Dr. Zapffe^is 
demonstrator of Bacteriology in his ahna mater. 

"96. C. E. Humeston, Austin, 111. 

"96. F. C. Glenn, 48th and Grand Ave., Chicago. 

"96. T. A. Lid, Marinette, Wis. 

"96. Emil G. Beck, 620 La Salle Ave., Chicago. Dr. Beck 
had an article on nasal inhalation of oxygen, in the June number 
of the Recorder. 

'96. Adolph Bonner, 1414 :)th Ave., New York City. 

'96. A. Doerr, 64s 7th St., Milwaukee, Wis. Dr. Doerr is. 
demonstrator of Bacteriology in Milwaukee Medical College. 

"96. Roy R. Eaton, Lowell, Mich. 

"96. H. A. Jegi, Galesville, Wis. 

"96. C. L. Barber, Albion, Mich. 

"96. Geo. S. Eddy, Anaheim, Cal. 

"96. G. H. Lawrence, Galesville, Wis. 

'96. W. R. Cheever, Kenosha, Wis. 

•96. S. J. Dobson, Edna, Kar. 

'96. Wilbur Mackenzie, 384 Garfield Ave., Chicago. 

'97. M. M. Brown, La Prairie, Adams Co., 111. 

•97. W. H- Wells, Erie, 111. 

'97. A. E. Brown, Grays Lake, 111. 

•97. H. D. Brown, Royal Oak, Mich. 

'97. Peter Bassoe, Iowa hospital for the insane, Mt.. 
Pleasant, Iowa. Dr. Bassoe has recently been promoted. 

'97. C. Gurber, Camden, Ark. 

•97. C. C. Calbreath, Confidance, Iowa. 

■97. Miles C. Barnett, Oshkosh, Wis- 

■i<7. .John J. Brinckerhoff, Minooka, 111. 

•97. Chas. W. Carter, Aledo, 111. 

'97. W. S. Lincoln, Dodgeville, Wis. 

•97. S. B. Dickinson, Austin, 111. 

■97. T. R. Jackson, Hocking. Iowa. 

'97. Lewis Frick, Hilbert, Wis. 

■97. M. L. .Johnson, 23 N. California Ave., Chicago. Dr. 
Johnson is lecturer on Materia Medica and ^Therapeutics] in 
Harvey Medical College. 

•97. E. E. Perisho, Ancona, 111. Dr. Perisho was mg,rriedl 
.June 27, ^99, at the Sherman House in Chicago. 

'97. D. D. Pence, 1392 Ogden Ave., Chicago. 

•97. F. S. Schendler, 262 S. Halsted St., Chicago. 



A/ II 1)1 III'. 181 



•97 

*97 
'97 
"97 
■97 
'97 
'97 
'97 
'97 
'97 



C. E. Sayre, 893 E. 43d St , Chicago. 
H. J. Stewart, lUls W. Lake St., Chicago. 
R. D. Smith, Bloomington, Ind. 
J. S. Wever, Leavenworth, Kan. 

E. M. Farquhar, Early, Iowa. 

W. S. Royce, 240 Honore St., Chicago. 
C. W. Verbue, Alvron, Ohio. 

F. W. Brodrick, Sinares, N. S. Mexico. 
J. F. Anner, Osage, Iowa. 

C. S. Bennett, Agnes Calientes, Mexico. 



NEWS ITEMS. 

Notice comes to the Plexus that four physicians are wanted 
for good locations in Minneapolis. Scandinavians are preferred 

Dr. W. August Evans has returned from a hunting and fish- 
ing trip in Montana and Dakota. He reports a very enjoyable 
trip, and now has a very generous supply of lion and bear stories, 
as well as fishy stories. 

Dr. Nerval H. Pierce, at the late International Otological 
Congress held in London, was made a member of the Interna- 
tional Committee of Arrangements. 

During the summer months the college building has been 
thoroughly renovated, the wall paijited, hard wood floors put in, 
the professor's stairway rebuilt with hard wood steps, and other 
changes made, the most pronounced change being the tearing 
out of the south w^all in the east end of the Pathological labora- 
tory, and a considerable portion of the laboratory partitioned off 
and made into rooms for the reception of surgical cases that are 
to be operated on in the clinics. This gives the surgeons greater 
facilities, and allows of a better and more satisfactory way of 
handling surgical cases. 

Dr. Bayard Holmes has returned from a sojourn in Europe. 

A number of the P. & S. Faculty went to Montana in the 
early part of this month for the purpose of hunting "big game," 
and from the stories they tell it was not their fault that they se- 
cured none. From Billings, Mont., however, comes the secret of 
their nonsuccess. 'Tis said that instead of carrying ammunition 
that would bring down such animals as lion, bear and deer, they 
went loaded only for snakes. 



FOOT BALL. 
From all appearances the P. & S. Football Team of '99 is the 
best that has ever represented the college. Judging from the 
appearances of the men in action, combined with their activity 
and weight, our team will make an excellent showing, and great 
things are expected of them. 

The games scheduled up to the present writing are as follows: 
Chicago — Lake Forest— Armour Institute — Michigan — Al- 
bion, Michigan State Agric. Col. — Northwestern — Wisconsin (y) — 
Monmouth (?) — Rush. 

The following members complete the '99 team: 

Played With. 
Wis. 
Mich. 

Vanderbilt 
Wis. 
Eureka 
111. 

Purdue 
Missouri 
Princeton 
Iowa 
P. & S. 
Milw. H. S. 
Notre Dame 
Nebraska 



Name. 


Weight. 


Dean 


170 


Lock wood 


210 


Hassett G. 


200 


Gary G. 


185 


Major Capt. 


220 


McCormick 


190 


Alward 


208 


Dowdall 


170 


Turner Q. B. 


155 


Mason H. B. 


160 


Monahan H. B. 


155 


Com stock H. B. 


175 


Maloy H. B. 


17.) 


Flippin F. B. 


180 


Total Weight, 


2,54S lbs, 


Average 


1H2 '• 




T. A DAVIS. M. D. 
Professor of l'fin<-ii)les of .<nr<:ery, Collese of Physicians and Sur-reons, Oiicaso. 




THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 

UNIVERSITY OF ILLINOIS. 



"VOL. V. OCTOBER 20th, 1899. NO. 6. 

ABOUT PERITONEAL ADHESIONS. 

T. A. Davis, M. D. 
Professor of Principles of Surg-ery. 

The recent advance made in many procedures of abdominal 
surg'ery has contemplated the lessening of peritoneal adhesions. 
The g3^necologist, by the protection of the intestines with lap 
sponges, from contamination and digital and instrumental manip- 
ulation; the clean removal of growths and diseased viscera; the 
covering of denuded areas with peritoneum; thorough haemos- 
tasis, and by closing the abdomen without drainage The apx^en- 
dectomlst follow the same principles^ and throughout the entire 
field of abdominal surgery, all operators aim to limit to the mini- 
mum degree peritoneal adhesions. 

That this subject involves one of the live issues of the day, 
let me call your attention to Dr. William Keen's article on "Re- 
section of the Liver, ■■ Annals of Surgery, Sept. "99. After the 
removal of a portion of the liver (including a carcinoma) with the 
thermal cautery, the raw surface left where it had been de- 
tached was thirteen by six centimetres. Dr. Keen says: "I 
deemed possible hse morrhage, or later adhesions and cer- 
tain free discharge of bile, good reasons for temporary iodoform, 
•gauze packing and drainage. The packing was removed in forty- 
eight hours. No haemorrhage occurred, but bile escaped to a 
considerable extent from the fourth to the twelfth day. In spite 
of this, if, in any future case I should haA^e to deal witli a small, 
charred surfaci^ after removing a liepauc tumor, I shall feel 
sorely tempted to test the absorbent powers of the i:)eritoneum 
^bv immediate closure of the abdominal incision without drainage. 



184 THE PLEXUS. 

If experience shows that no ill results follow, I would then test 
the method in cases in which the escape of bile would probably 
be larg-e. 

Possibly the peritoneum will absorb it all, and if not, a later 
small incision, or possibly even asiDiration alone, might be suffi- 
cient to remove any accumulation. 

At all events the procedure is worthy of consideration. This 
is the thought of one of our most eminent surgeons. The idea 
being first, that in this liver resection the proper work done with 
Baqueline's thermal cautery at "a dull red heat," would prevent 
subsequent parenchymatoas hsemorrhage hence there was no 
need of the iodoform gauze packing as a preventure of hsemor- 
rage. Second, a minimum inflammatory reaction (aseptic) w^ould 
arise, resulting in less extensive adhesions than from the larger 
surfaces which would be exposed to the iodoform gauze packing, 
and subsequent granulation. Third, we would not apply theprin. 
ciple of drainage where there is no indication for it. Fourth, a 
belief that bile is less injurious to the peritoneum than we have 
formerly been taught to believe, or there is less danger of its be- 
coming diffusely extravasated — being encysted by early adhesions. 

If the doctors' premes are correct his suggestions will be of 
value, and we shall dispense in some cases with the needless, yes 
harmful, practise in our technique, the extensive gauze pack. 

Lest my remarks should influence some of my younger 
confreres to the early adoption of such suggestions let me say 
that we should wait for the experiences of Dr. Keen or other 
masters in abdominal surgery. In the meantime we have im- 
mediate safety to life in the present custom and must battle with 
the remote consequences should they arise. 

Before the consideration of my work I will entertain the 
readers of the Plexus with a most interesting article by Josser- 
and and Goinard, of France, reported in the Lyons Medical 
Journal. It was translated for me b}^ Dr. Max Friedel, of this 
city. 

A special property of all the serosas and in particular of the 
peritoneum as is known by everyone, is to react to various irri- 
tations by the formation of adhesions. A large part of the 
abdominal surgery depends upon this property and from a patho- 
logical point of view the modus of production and the role of 
peritoneal adhesions in hernia, ovarian cyst and pelvic affections 
in the female have been studied for soma time. It has also been 



Peritoneal Adhesions. 185 

long- known that these adhesions can never be without danger, 
and that acute or chronic intestinal obstruction could be the 
result of the surrounding of an intestinal loop by a frenum-like 
band, or its fixation (abnormal) by a more or less developed 
adhesion. 

Thus, until very recently, no more attention was paid to 
those peritoneal adhesions than to look upon them as conditions 
occasionally beneficial, because limiting peritoneal infections, at 
other times unfavorable, because complicating the operative 
management of certain surgical interventions, or becoming the 
cause of such obstructions. 

Since the advent of the antiseptic era and the great extension 
of abdominal surgery during the last twenty years, these ad- 
hesions have become very much more important. We came to 
recognize their frequency after laparotomy, and knowing the 
danger of obstruction occasionally engendered by them, we 
have — in order to prevent their formation — established the prac- 
tice of preventing the peritoneum from coming in contact with 
irritants, antiseptica and of never allowing a bleeding surface in 
the pelvic cavity. 

From a pathological standpoint their importance has become 
a still greater one, since w^e have found, that appendicitis, 
choleystitis, gastric ulcers and almost all genital affections in 
the female are complicated by adhesions, and also have begun 
researches for their role in the pathogenesis of symptoms. 
Moreover having recognized that situations created by them 
were apt to frequently overshadow— those resulting from the 
causal affection, we have begun the practice of such surgical 
interventions as are directed directly against them And thus 
the "pathology proper"' of peritoneal adhesions came into 
existence. 

Gynecologists have demonstrated that pains of a very per- 
sistent nature would disappear after the freeing of the cul-de-sac 
of Douglas from adhesions. The role, however, of adhesions 
appearing in other regions of the abdomen had been less studied. 
Crede has shown as far back as 1887, that those adhesions 
involving the intestines may be the cause of very grave colics 
which justify laparotomy. Since then, analagous facts have 
been reported by others, viz: Terrier, Nicaise in France; Riedel, 
Lauenstein in Germany; and Tappey in America, whose works 



18B THE PLEXUS. 

have been reviewed in a recent treatise by Mr. Bouquet de 

Jolinieres. 

These researches have shown that, aside from intestinal 
obstruction by frenum or flexion, which shall not be considered 
here, peritoneal adhesions may bring out conditions which are 
sometimes grave enough to justifj^ surgical intervention. Said 
conditions again consist of painful phenomena peculiar enough 
in tlieir characteristics to make possible the recognition of their 
origin, and are frequently accompanied by functional disturb- 
ances differing in nature and intensity according to the organ 
invaded and to the infinitely variable forms of adhesions. 

But this history is still nothing but a mere outline, both 
from clinical and from a therapeutical point of view. The 
clinical signs upon which the diagnosis and a decision for sur- 
gical intervention might be based, are still quite obscure and 
little known: and even the opportunity of an operation is still 
under discussion. 

The observations which we shall relate here may be con- 
sidered as our contingent towards that yet so incomplete history 
of painful peritoneal adhesions; they make conspicuous one fact, 
which, to the best of our knowledge up to the present time did 
not receive any attention from any one side: i. e. That also 
post-operative adhesions may become like others the cause of 
both grave pains and symptoms. They furthermore shovr that 
it is quite frequently possible to base upon them a diagnosis of 
sufficient certainty as to justify an operative intervention, which 
in our three cases has given results, very satisfactory indeed. 

Obsekvation I. P. J. 22 years old, entered the 

"Charite" during the month of December 1895, and was assigned 
to the care of Mr. Levrat, whom Mr. Nove-Josserand assisted. 
The patient was suffering from ovario-salpingitis which had 
previously necessitated the the incision of a gathering in the 
posterior cul-de-sac. 

The pains having persisted since then in spite of all medical 
remedies it was decided to perform the operation of hysterectomy 
per vaginam. 

This was done December 13th, the procedure being the 
median incision of Quenu; it was relatively simple, as the annexa 
of the left side had to be left in i:)lace, said adnexa being very 
adherent. 

The first days following the oj^eration everything was 



Perifonedl Adlu'sions. 187 

normal; but towards the tenth day the patient began to experi- 
ence again violent and continual pain in the left groin (tiank), 
without exacerbation and without any perceptible relation to 
peristalsis. 

The pains were attributed to the left ovary and by reason of 
their persistance it was decided to remove that organ by 
laparotomy . 

This was done on February 1st, 1897, by Mr. Pollosson. 
It was found that ovary and salpinx were attached to an intes- 
tinal loop by an adhesion forming a short and solid frenum. 
This frenum was removed or rathed detached, followed by 
the ablation of ovary and tube. Drainage a la Mikulicz. 
Patient recovered without further incident. 
We saw her last a year and a half after the operation; she 
had continued in excellent health and had not felt any more pain. 
In this case the phenomenon of loain conld be attributed to the 
persistency of the ovary; but we must keep in mind that the lat- 
ter had been found approaching manifest atrophy, as such is the 
rule after vaginal hysterectomy; it is, however, more probable 
that the intestinal adhesion was the principal cause. 

Observation II. G. P , 20 years old, had been operated 

upon by Mr. Vallas, Nov. 1895. A ]3elvic abscess had been open- 
ed by way of the vagina. 

After the operation the patient felt relieved, but shortly af- 
terwards the pains recurred and remained persistent, in spite of 
rest in bed for tw^o months, of revulsives and of internal medica- 
tion. 

On Aug. 25, Mr. Nove Josserand performed laparotomy fol- 
lowed by bilateral ablation of the adnexa, and no difficulties were 
encountered. 

During the first four days there was no fever, but on the 
fifth day there began to appear symptpms of infection which be- 
came quite alarming. Examination disclosed the formation of a 
pus cavity, which, on Sept. 22, was opened by way of the vagina. 
After that, recovery followed. 

During all these events the constipation remained obstinate; 
stool could be obtained only through energetic purgatives, and 
were accompanied by extremely severe pains. 

These conditions remained unchanged after healing was com- 
plete; the patient continued to feel pains of a very peculiar na- 
ture. These pains lodged themselves in the left side and were 



188 THE FLEXUii. 

continual; but there would also be exacerbations, in the form of 
colic, springing up unexpectedly about two hours before defeca- 
tion, and disappearing just as sudden after the depletion of the 
bowels. And, moreover, simultaneously with the crises of those 
pains, there appeared in the iliac fossa a tumefaction which like- 
wise disappeared after defecation, thus establishing a plain caus- 
al-nexus between the repletion of the bowels and the exacerba- 
tion of pains. 

In view of the insufficiency of medical treatment, liquid ali- 
mentation and local revulsions, Mr. Nove Josserand decided up- 
on the performance of laparotomy. 

On Dec. 17, incision along the linea alba. The epiploon is 
found to be adherent to Poupart's ligament. This adhesion is re- 
sected between two ligatures. 

A part of the Sigmoid Flexure was united with the parietal 
layer of the peritoneum by adhesions of which one part fibrinous 
and whitish-forms frena of several cm. in width which was cut 
through with the bistoury, while other parts of filiform struct- 
ure surround the terminal part of the large intestine along its 
whole iutra-peritoneal course. These parts of the latter variety 
were deglutinated by the finger, and only a slight hemorrhage 
ensued. 

During the following days the pains diminish and finally dis- 
appear; On Jan. 7, the patient left the hospital. 

Since then the patient has been seen by us at different times. 
She has slight pains only, which are colic like, and appear in the 
left iliac fossa, beginning unexpectedly about oae half hour be- 
fore defecation, and accompanied by a tumefaction on the same 
niveau (level) and a sensation of intra-abdominal movements. 
These i)henomena disappear immediately after defectation, only 
to re- appear before the following one. 

There does not seem to exist any tendency for spontaneous 
improvement, and the condition of our patient remains almost 
stationary. The most she feels are nervous troubles, flashes of 
heat, resulting from the ablation of the annexa; but on the whole 
her condition is quite tolerable, and her state is not to be com- 
pared with that in which she found herself during the months 
preceding the last surgical intervention. 

Observation III. G. B ,21 years old. Is suffering 

from metro-salpingitis and has already undergone two curette- 
ments. 



Peritonpid Adhesions. 189 

Mr. Nove- Josserand, after having tried medical treatment 
for a long time without success, performed laparotomy; the an- 
nexa on both sides are ablated, and finding the appendages turg- 
escent and fixed to the right ovary by adhesions, he performs 
resection. 

The post-operative sequels are simple. Aside from an ob- 
stinate constipation there was a slight elevation of temperature; 
the thermometer registering 38.2 on the evening of the third day, 
it rises to that mark from the ninth to the fourteenth day every 
evening, or to 38.3; once to 38.5. After that complete apyrexia. 

After the first days the patient complains of pains in the 
right side, she again feels continual pains in that region which 
increase at certain moments, without any reasonable explanation 
of any connection of these painful phenomena with either defec- 
ation or intestinal motion. During several days she experiences 
pains radiating down the right thigh, which latter is somewhat 
oedematous: these pains prevent the patient from holding herself 
erect, and compel her to bend forward when walking. After an 
exacerbation of the pains, plainly in report with a "catching 
pain", she leaves the hospital, feeling improved. 

She presents herself from time to time. She suffers always, 
and at certain times, greatly; so that the pain makes her scream, 
and she is obliged to go to bed. These exacerbations are irregu- 
lar, and come on unexpectedly and without api^arent cause. The 
abdomen is sometimes tymi)anitic. Pressure on the level of the 
cicatrix is painful; there, and in the right ttank, resistance is 
greater than from the wall itself. On rectal and vaginal digita- 
tion a pulfiness is encountered. 

On Aug. 6, 1897 the patient re-entered the hospital. She 
has suffered greatly during the last few days, and has screamed 
with pain during an entire night; her sufferings instead of dimin- 
ishing have increased. She is pale and emaciated, and it is plain 
that her condition has grown worse. 

On Aug. 11, laparotomy divulges an adhesion of the epiploon 
to the parietal peritoneum in the whole right flank. The epi- 
ploon is deglutinated, and where there are rents from this deg- 
lutination, ligatures are placed. It is foand that there are no 
lesions upon the ceacum, and no traces of adhesions upon either 
the large or the small intestines. 

After the operation the pains diminishes considerably. The 
patient_left the hospital feeling better than ever. 



1*H) THE PLEXUS. 

From the point of view of the pathogenic role of peritoneal 
adhesions these three observations do noc prove alike. In ob- 
servation II. this role is incontestable. The clinical signs which 
have permitted a diagnosis before any intervention, and the al- 
most complete disappearance of pains immediately after the de- 
struction of the adhesions prove beyond a doubt that this inter- 
pretation is correct. One might rather doubt the fact of that 
role in observation I. , where the existence of a partially atro- 
phied ovary is amply sufficient to explain the symptoms, and also 
the fact in observation III., in which the result is too recent to 
be regarded as definite- 

We have, however, thought that, in spite of these few reser- 
vations, the facts obtained could be interpreted as painful peri- 
toneal adhesions. At any rate they are of veritable interest, be- 
cause, in regard to symptoms and therapeutic results, they are 
closely related to observation II. 

And resting upon these data, and those which we have found 
in literature, we shall now endeavor to resume the history of 
these painful peritoneal adhesions. 

The great cause of peritoneal adhesions is inflammation, 
acute or chronic, generally accompanied by serous or purulent 
exudation. Is this cause unique, and are not adhesions possible 
outside of inflammatory processes? It has been claimed that 
repeated contusions of the abdomen may be sufficient for their 
production, and Riedel has furnished several observations in sup- 
port of this theory. But these facts seem to us far from being 
demonstrative. In the first place, the pathogenesis appears to 
us very obscure, and it is difficult to understand that two serous 
surfaces should adhere one to the other without epitheleal des- 
quamation; produced by a certain degree of irritation. 

Moreover, this etiology has not been proven, either clinically 
or experimentally, for, before admitting the etiological part cf 
such contusions the entire absence of inflammation should have 
been proven, and this has not been done. It is also admissible to 
suppose that aseptic irritations of the peritoneum, such as are 
caused by contact with caustics or strong antiseptica, are capable 
of producing such adhesions. But from our point of view this, 
as little yet studied question, is of no great importance, and until 
more ample demonstrations are given, we shall consider these 
adhesions as the result of inflammatory irritation, due to a slignt. 
degree of infection. 



Pfnitotu al A(J]i( t,i(iiis. 191 

Inflamniatioii may attack the peritoneum primarily and thus 
produce the different varieties of primary peritonitis; but moso 
often the attack upon the peritoneum is of a secondary nature^ 
being a consequence of inflammation of one of the organs which, 
it covers, and thus are developed the different varieties of sec- 
ondary, circumscribed peritonitis. 

Now, as all these forms of peritonitis are causative of adhe- 
sions, we have here a very complex etiology, which should em- 
brace also the primary peritoneal inflammations, diffuse or cir- 
cumscribed, viz. : Simple inflammatory peritonitis, tubercular 
peritonitis, and all the peritoneal inflammations consecutive ta 
lesions of the digestive tract and its annexa; gastric ulcers, enter- 
itis, dysentery, appendicitis, peri-hepatitis, chole-cystitis, peri- 
splenitis, vesical inflammation, and especially inflammation of 
pelvic organs in the female, as metritis, salpingo-ovaritis. 

Besides these adhesions which develop as a result of spon- 
taneous inflammation, it appears to us that an important place 
should be given to those resulting from surgical irritation, and 
which are consecutive to intra-abdominal operations and in gen- 
eral to laparotomy. 

Indeed, it is universally admitted to-day that the multiple 
causes of irritation, contact of fingers and of instruments, action 
of antiseptics, produce these adhesions, be it directly according 
to the opinions already cited — be it, as we are inclined to believe. 
by a slight degree of infection. 

This enumeration shows the frequency of peritoneal adhe- 
sions. It is, however, certain that in a good many cases they do 
not cause any illness, and are void of any or ail symptoms. We 
shall try, presently, to show why, in certain cases, they become 
the cause of disease. 

The diversity of causes explains the variety which is ob- 
served in regard to location and anatomical forms of peritoneal 
adhesions. At one time, for instance, we find them limited to 
one single spot in the vicinity of the diseased organ; at another, 
they will spread far beyond that limit. And while it is no unrare 
case to find adhesions, produced by appendicitis, extending up to 
the gall-bladder, such as are consecutive to pericholest cystitis, 
may just as well accompany the whole length of the ascending 
colon. And especially will we mention here those post-o]3erative 
adhesions which form upon cicatrices or in their vicinity, or else 
at the level of and with organs which were involved in the sur- 



192 2he Plexus 

gical iutervention winch are most often those within the pelvis. 

Now. although the formation of adhesions may take place 
upon anj' of the various organs, we ought to consider above all, 
those organs which are in direct connection witn either the small 
intestines, the large intestine or the epiploon. As the history 
of ovario-tubul adhesions is somewhat peculiar, we shall naturally'' 
leave it aside. 

The small intestines may be either fixed to any point in the 
abdominal cavit}' or else, under the most different possibilities, 
be connected with any adjecent loop of its kind. 

The large intestine is generally adherent to a part of the 
pelvic peritoneum in its vicinity. 

The epiploon finally may attach itself entirely, or may give 
rise, either upon itself or through co-existing intestinal adhe- 
sions, to the most numerous forms of adhesions. 

If we consider the structure of adhesion itself, we can, with 
Nicaise, differentiate three kinds, whereby we leave out recent 
ones, as they are not definit, and therefore do not deserve of any 
consideration. 

(a) Adhesions formed by areolar tissue, cells being minute 
and loose. 

(b) Adhesions of a filamentus or membraneous structure 
and stretched out, thereby forming either frenuli or annular 
bands, but not holding the parts involved in contact with each 
other. I 

(c) Adhesions of more or less extension, which consolidate 
the parts involved within themselves. 

We may, however, encounter all the different types and it is 
therefore almost impossible to classify them into categories 
sharply defined. Moreover, diverse forms may co-exist, as for 
instance a large adhesion of straight extension and being quite 
broad, beside a long and narrow frenum which diminishes or 
.shuts up the caliber of the intestine. 

Such was the constellation in our observation II, where the 
epiploon was fixed by such an elongated frenum, while the sig- 
moid flexure Avas immobilized at its terminal end by a filamen- 
tous tra'-tus covering a large part of its surface. 

Peritoneal adhesions are far from always giving rise to per- 
ceptible symptoms, and just the latent form is certainly the most 
frequent one. 

We ne3d in this connection only to remember the consider- 



Peritoneal Adliesfians, 193 

-able number of laparotomies, which are neither functional 
troubles nor by even a single phenomena of pain. If, however, 
as a general rule, adhesions do not manifest themselves by any 
symptom or symptoms, why is it that in certain cases they 
cease to remain latent? One is often inclined to make a peculiar 
individual disposition thereto of the subject him or herself 
responsible for; for instance hypochondriasis or hysteria are 
enumerated among them, and it is then supposed that such a 
disposition may act as exciting cause while latency will remain 
undisturbed in a normal person. 

This may be true in certain cases, but doubtlessly this 
explanation is likely to be abused, and the therapeutic results 
show, that, in general, the occurrences due to adhesions can be 
explained by a disposition peculiar to those which impair the 
functions or organs or which produce tension. Let us mention 
right here, that intestinal adhesions often manifest themselves 
by typical intestinal obstruction; but we shall leave the cases of 
kind in order to occupy ourselves with perhaps rarer cases, in 
which they manifest themselves by occurrence less acute and 
more grave, among which the painful phenomena take first 
rank. 

The pains which are the most constant symptom of the 
lesion which we are considering, display a variety of character- 
istics; sometimes there is a persistent pain in a fixed spot. The 
patient in observation I complained constantly of pains in the left 
flank. This was a fixed pain, continual and without any of the 
characteristics of colic, and also not influenced by the process of 
digestion, circulation of fecal matter within the intestine, or 
defecation; yet in this case the adhesion was on the small intes- 
tine. Likewise, the patient in observation III felt continual 
pain, presenting also the characteristics of lecation in a precise 
place, the right flank. 

Hence there are cases in which the sole peculiar character- 
istic is the fixity in a definite spot; in these cases thorough 
palpation may sometimes produce an exaggeration of the suft'er- 
ing, as was shown in the patient of observation III. 

In other cases, the pain instead of being fixed and continual, 
takes upon itself the form of colics, reassembling hepatic colics 
and others. Thus, the patient in observation III experienced 
during different relapses of atrocious colics for several hours, 
which are accompanied by neither emesis nor any other sign of 



194 Ihr Flexus. 

obstruction, and it was following one of those crises that surgical 
intervention was decided upon. At intervals between the 
painful crises the patient maj^ continue to feel dull pains or, on 
the contrary may not feel any single painful sensation; in other 
words, the pain according to the case, may either be intermittent 
or remittent. The paroxysms of pain, instead of presenting no 
regularity in their appearance may be ia close report with the 
j^hysiologic functions. Thus, in the instance of the patient in 
observation II, the pains were plainly in close report with defe- 
cation; they sprang up several hours before, and increased \)Vo- 
gressively, only to stop in an abrupt way and completely as 
soon as dejiletion had taken place. 

Such relation between pains and physiological functions has 
been observed also in adhesions concerning the stomach 
(iSIicaise), or the bladder (Tappey). Where gastric adhesions 
were concerned, the painful phenomena appeared (Nicaise) some- 
time after ingestion of nourishment, increased in proportion to 
the progress of digestion and culminated in vomiting, to cease 
only after evacuation of the stomach. 

In the observation of Tappey it is the bladder which is 
involved at the same time with the large intestine. "In a recent 
ease" says he "oophorectomy was followed by -a very grave per- 
sistent form of cystitis and by tremendous pain in the stump of 
left broad ligament. Two years after that operation the abdo- 
men was again opened, when it was found that the colon was 
adherent to the vesical wall and the pedicle of the broad liga- 
ment. The first named adhesion explained the persistent 
cystitis which in all probability has been caused through trans- 
migration of the bacillus coli through the walls of the intestine 
and the bladder respectively. The paia was caused by tension 
(traction) upon the surface of the pedicle of the broad ligament." 

The character of the i^ains is likely to be modified under 
certain circumstances; thus, there can be a more or less marked 
exacerbation under the influence of menstruation, of intercurring 
infectious conditions, and notably the Grippe. But such exacer- 
bations may api^ear suddenly, also aside from these influences, 
and therefore, as we have already said in the beginning, they 
cannot be laid exclusively to the account of general conditions, 
as for instance, hysteria or hypochondriasis. 

The functional troubles which depend upon adhesions,are like- 
wise very variable, when the intestine is involved, the pains are ac^ 



Prrifour-l/ Ad/ies/nlis. 195 

•companied by a more or less obstinate constipation: but as that 
never goes far enough to arrest completely fecal matters and 
gases, it is always possible to obtain evacuations. We should, 
therefore, not consider these phenomena, which we treat here, as 
being caused simplj^ by intestinal obstruction. It is rather pos- 
sible that the diminution of the intestinal caliber by compression 
or indentalion plays also a great role in the pathogenesis of 
events or occurrences of that kind. But it is not to be doubted 
that exaggerated and painful peristaltic contractions, real intes- 
tinal colics and the drawing of the adhesions must not be placed 
in the first rank. 

The functional troubles are less understood and less dwelt 
upon where other organs than the intestine are involved. Still 
in cases of gastric adhesions, frequent emisis which occured in 
the moment of the paroxisms of pain and led to the cessation of 
pain, has been pointed out as almost conclusive evidence. 

The function of the bladder may also be impaired, and with- 
out admitting so readiiy, as Tappey did, the invasion of the 
bladder by the bacillus coli, we believe that certain difticultiesan 
micturition (cystitis absent) so frequently seen in cases of sal- 
pingitis and appendicitis, can, with at least some i^robability, be 
connected with the existence of vesical adhesions. 

Summing up: The intra-peritoneal*adhesions which do not 
remain latent, disclose themselves by continual or intermittent 
pains, accompanied or not by functional signs, as: constipation, 
dysuria and cystitis. 

"When the pains are accompanied by clearly defined difficul- 
ties in the function of an organ, the diagnosis becomes self-evi- 
dent; thus, in observation II, the cause of the events could be 
very readily recognized, being characterized particularly 'by 
pains coincident with repletion of the rectum. But it is rarely 
that the signs are so plain; in observation III one hesitated a 
long time because the digestive functions were of no influence 
upon the painful phenomena. 

Therefore then, in the absence of clear signs of adhesions 
upon the large intestine, or perhaps the stomach or the bladder, 
the diagnosis may be very difficult, and often it might be impos- 
sible to recognize, clinically, adhesions involving the small intes- 
tine or the epiploon; the only symptom in similar cases is the 
persistent pain fixed to its seat. 

Also, very frequently the diagnosis is not made until after 



U^O The Plexus. 

the performance of laparotomy: the coutmual pains lead to the 
operation on the patient, and adhesions are found to the account 
of which the phenomena observed can be brought, i. e. a retro- 
spective diagnosis is made. 

But as it is very often impossible to affirm the existence of 
adhesions by clinical signs, we should at least be able to make a 
diagnosis of i^robability, and guess the cause, especially if we 
see the painful data appear and persist indefinitely after inflam- 
mation or after a peritoneal intervention somewhere. 

And if the pains are intense enough and persistent enough, re- 
course should be taken to exploratory laparotomy. It should, 
however, not be forgotten that hysterics may also present events, 
likewise painful, fixed and persistent, and that in spite of any 
treatment employed. And therefore, we should be less affirma- 
tive, when dealing with persons presenting the stigmata of hy- 
steria. But the inverse error is still more to be regretted, and 
perhaps many a woman has been wrongly, injuriously, considered 
to be hysteric, while in fact she was suffering for a laparotomy 
and her sufferings would have been assuaged by but one inter- 
vention. 

By reason of the difficulties which the diagnosis of intra-per- 
itoneal adhesions (a few special cases excepted) presents, the 
therapeutics must be a matter of serious thought. Some sur- 
geons have raised the question with themselves, whether, in 
cases of that kind, intervention were fully justified, and Roux, 
for instance, even advises abstaining from it, thereby footing up- 
on resorption, almost constant with exudates and leading to the 
disappearance of the events. 

It is certain that frequently such spontaneous resorption 
takes place, and we are the first to say that, above all we should 
wait and take recourse to medical treatment, i. e. liquid alimen- 
tation, revulsions on the painful spots and regulation of the 
stool. And we think that we may often have the satisfaction of 
seeing the events amending themselves and the pains disappear- 
ing. Is this not -the history of a great number of individuals op- 
erated upon for appendicitis, salpingitis and cholecystitis.? 

But does it follow that, in spite of all, we must wait for such 
spontaneous recovery? Certainly not, if several months have 
elapsed and the pains, far from stopping, have increased as well 
as the functional troubles. We do not doubt that an intervention 
and be this only exploratory, is fully justifiable. 



Peritoneal Adhesions. 197 

But there is still another argument invoked in favor of ab- 
staining from intervention; this is the impossibility of prevent- 
ing with certainty any new adhesions after lajDarotomy. "The 
intervention is useless," they say, "because such new adhesions 
would prove almost fatal."' This skepticism resorts a little to 
the researches of Riedal although that surgeon does not say so 
positively, and on the whole, advises laparotomy. We ourselves 
shall remain partisans of Nicaise, Crede, and, deciding for inter- 
vention, thereby footing upon the results which we have obtain- 
ed in our three patients. 

The first one, having been operated upon eighteen months 
ago, has not felt any pains since the adhesions have been resec- 
ted. 

The second one, operated upon six months ago, has improved 
very noticeaoly, her pains, which had caused her to scream and 
to take to bed two or three hours before each stool, have assuaged 
so that there are none but slight colicky pains, and she is now 
able to attend to business, leading an existance quite normal. 

We cannot, however, be so positive in regard to the last of 
our three cases, as there the result is still of too recent date. 
But she too, immediately after intervention, had felt her pains 
disappearing almost completely, and we have all reasons to be- 
lieve that they have not recurred. 

Relying upon our personal facts, we think ourselves entitled 
to assume that laparotomy, and deglutination or resection of ex- 
isting adhesions produced a very happy influence. And this is 
also the impression received by us from literature, hitherto pub- 
lished upon that subject. 

If there was not always obtained a complete recovery, there 
was accomplished in all cases, at least, considerable assuage- 
ment of the symptoms. 

This result. may be explained quite well: There is no doubt 
that it is impossible to prevent, with certainty, the formation of 
new adhesions, especially in cases where the adhering surfaces, 
which the peritoneum has roughened off, remain in the presence 
of each other; but it may at least be hoped that these adhesions, 
be less strong than the preceding ones, as the second interven- 
tion can be more rigidly aseptic. Moreover, as experience has 
taught, we can, immediately after the operation and during the 
days following it, bring into play, and that in a high degree, the 
mobilization of the intestine by purgatives, and can accomplish 



193 The Plexus. 

ill that maiiuer that the new adhesions be limp enough not to in- 
terfere with the functions of the organs and be not exposed to 
too great a strain. 

We take the stand that an intervention is justifiable after 
one has waited long enough to be sure that no spontaneous re- 
sorption can be expected and that the symptoms will persist or 
become aggravated. 

We shall not here describe the details of this intervention, 
which are, besides, necessarily variable according to the case; 
but we will mention some peculiar points. 

When the abdomen is opened the search for adhesions is 
sometimes very dilficult, especially as the location could not be 
precisely determined: in cases of pelvic adhesions Trendelen- 
burg's position will be of great service. 

When the adhesions are recognized the manner of ^Drocedure 
varies with their nature and their location. Adhesions of the 
epiploon are detached b}^ the fingers, or, if necessary, are 
resected after convient ligatures have been placed. For intes- 
tinal, vesical, or biliary adhesions various instances may jDresent 
themselves. So, for instance, a frenum of oreolar structure 
extending over a large surface, but of soft consistency, is very 
easily detached by the tip of the finger; in this manner we have, 
in observation II, detached a considerable quantity from the 
sigmoid flexure and the rectum. Long and resisting bridges of 
adhesive tissue, if vascular, are resected after having been 
ligated at both ends. The most dilficult case is of intimate and 
extended adhesions completely fused ivlth the ivalls. Here we have 
to guard against perforation and the utmost care is necessary; 
fortunately such cases are rare. 

After the adhesions are destroyed we should endeavor to 
prevent their recurrence by emploj^ing energetic purgatives, 
lavage and electricity, beginning therewith on the morning 
following the operation. The facts which we have here reported 
bid fair to let us ho2)8 that the profession will soon concur in our 
opinion. 

But it is cartain that the proper treatment should be prophy- 
lactic, if possible, as for instance, after operations. From fear 
of post-oi^erative intestinal obstructions surgeons now-a-days 
agree upon the necessit3^ of prev^enting adhesions by strich 
asepsis, exast closure of bl jeiing surfaces and abundant purg- 
ation. The idea of painful phenomena, and functional troubles 
due to these adhesions should make the application of these 
rules doubly scrupulous. 



CLINIC\L LABORATORY DEPARTMENT. 
W. E CoATES. M. D. 

PARA8I11C Oniai}^ OF 7 dMOR.— Continued from 
July Plexus. — 

An epithelioma," according to Kahane, "may be tenta- 
tively defined as the expression of a peculiar symbiosis of epithe- 
lial cells, leucocytes and saccharomycetes. "" 

"Practically all the characteristics of cancer,'" accordins: to 
Park, "are explained by the well-known activity of parasites, 
which tend, for the most part, to an intracellular {InfercelhUar'i) 
life, and which rarely jDenetrate the cells themselves except in 
search of pabulum or as a result of pressure.'" "Work carried on 
in the laboratory equipped and maintained by the State ofNew 
York, under the directorship of Park, finds in virtual^ every 
fresh specimen of cancer bodies which cannot be other than par- 
asites, though whether th^y are fungi or sporozoa is still unde- 
termined." 

The above quotations from recent publications represent 
fairly well the current views on the parasitic origin of lumors, 
Kahane voicing the views of the Itali*an school, that blastomy- 
cetic or yeast-like fungi are the determining cause, Park repre- 
senting those who admit the probable parasitic origin of neo- 
plastic growths, but who yet halt between two opinions, unde- 
cided as to the animal or vegetable nature of the parasites. 

These elements of certainty and uncertainty dominate the 
literature on the subject for the last four or five j^ears, but here 
and there apparent facts stand forth, too firmly grounded to be 
overlooked, pointing to the coming day when the parasitic origin 
of tumors will be an accepted fact in pathology. 

In the following review of the work on the parasitic origin 
of tumors carried on during the last few years, it is to be re- 
gretted that American workers have contributed so little to the 
vexed question under discussion. A careful search of the late 
literature discloses the fact that we must depend, for the present 
at least, on the researches of Italian, French, German and 
Eno-lish investisj-ators. 



200 The rU'xns, 

Of the Italian workers, the results obtained by Sanfelice, of 
the University of Cagiiari, in Sardinia, and Roncali, of the Uni- 
versity surgical clinic in Rome, merit the closest attention. 
Sanfelice published his first paper in January, 1895, and was 
followed by Roncali with his first paper a month later, since 
which time both have contributed a number of valuable papers 
to the journals of Europe. 

The facts worthy of notice as brought forth by Sanfelice, 
Roncali and their followers, have been tabulated as nearly as 
possible in the following pages: 

Sanfelice made subcutaneous inoculations into guinea pigs of 
a yeast which he terms saccharomyces ellipsoideus neoformans. 
These animals died, on an average, in thirty days. The inocula- 
tion was in a few days followed by a local swelling, which might 
or might not break down, together with enlargement of the lym- 
phatic glands of the groin and axilla. 

The i^ost mortem showed the tumor in the subcutaneous 
tissue to be soft, not firmly adherent to the skin, and presented 
an appearance like that of fish flesh; the lymphatic glands pre- 
sented a similar appearance; the spleen was enlarged and studded 
with elevated whitish nodules; the liver was slightly enlarged, 
and rarely showed the whitish spots seen in the spleen. These 
spots or nodules were more common in the kidneys than in the 
liver; the intestinal follicles and lymphatic glands were enlarged; 
whitish areas were found in the lungs, which were also somewhat 
enlarged. No microscopic changes were found in the brain, 
heart and adrenals. 

Inoculations into the testicles of guinea pigs caused death 
in the course of twenty-five days; testis and epididymis were 
enlarged and contained fish -flesh like masses. 

Inoculation into the liver resulted in the development of sin- 
gle and multiple tumors in that organ. 

Intra-abdominal inoculations gave the most marked changes, 
and resulted in a severe peritonitis, which Sanfelice termed a 
neoplastic peritonitis. Viseral nodules, as previously described, 
containing enormous masses of blastomycetes, were also present. 
Histologically the tumors consist of a network of young con- 
nective tissue, in the meshes of which are found a variable num- 
ber of cells resembling lymph corj^usles. Many leucocytes con- 
taining blastomycetes were observed. Parasites were so abun- 
dant as to constitute the greater part of the nodules. The ma- 



P(iy\(s!t!c Origin of Tumors. 201 

jority of parasites lie free, and vary in their staining quality. 
The enlargement of the lymph glands depends more on the 
immense number of parasites present than on a proliferation of 
the cellular elements. 

The parasites could be demonstrated in nearly all the organs, 
but produced no reactive inflammation. The absence of epithelial 
hyperplasia in guinea pigs is explained on the ground that death 
occurs too soon for it to take place. 

Sanfelice then points out the striking similarity between the 
appearance of the blastomyces in the tissues and the so called 
coccidia described by many writers as occurring in the malignant 
tumors of man, and concludes that the latter bodies are not pro- 
tozoa, but blastomycetes, a view that had been previously ad- 
vanced by Russel. 

Later experiments with saccharomyces neoformans yield 
equally interesting results. 

In two out of thirty dogs, inoculations made into the posterior 
mammary glands were followed by the formation of a tumor in 
situ, and by multiple metastases in the internal organs. 

Three roosters, out of eight inoculated, presented neo- 
plasms. 

Ten mice inoculated in the x^eritoneal cavity died in eight 
days. Miliary nodules were found in the omentum and, not 
always, small gray spots in the spleen and kidney. Saccha- 
romyces were found in the organs and 'several times in the blood. 

White rats. — Of two inoculated under the skin, one died in 
one and one-half months and the other in two months. At the 
point of inoculation both show^ed a growth the size of a hazelnut; 
miliary nodules were found in the omentum, the spleen and mes- 
entery were swollen, small gray specks were found in the kid- 
neys; saccharomyces were observed in the organs, but not as 
numerous as in mice. 

Rabbits. — Subcutaneous inoculations in four were unsuccess- 
ful. Of eight inoculations into the peritoneal cavity, two died in 
from one to one and one-half months with swelling of the ingui- 
nal and axillary glands, and nodules in the spleen and kidney. 
In the organs the blastomycetes were not as numerous, but the 
new formations of cells were more abundant than in mice and 
rats. 

Dogs. — Of the thirty dogs inoculated in various ways, only 
the two inoculated in the mammary glands showed tumors at the 



202 Ihe Plexus. 

point of inoculation and in the various organs. One was Killed 
in two months and the other died in ten months from tumors 
which Sanfelice calls epitheliomata. 

In November, 1895, Sanfelice described another pathogenic 
blastomyces which was obtained from the lymphatic glands of 
an ox that died of primary carcinoma of the liver, with metastasis 
to all the lymphatic structures of the body. This pai asite resem - 
bles the saccharomyces neoformans in its growth or artificial 
media, staining reaction, etc , but differs from it in that its growth 
is accompanied by a peculiar hyaline, calcareous or glassy degen - 
eration, hence the name — saccharomyces litogenes. 

Subcutaneoas or intra-peritoneal inoculations of this parasite 
into guinea pigs resulted in their death in about two months. 
The lymphatic glands w^ere found to be enlarged, hemp-seed-iike 
nodules were found in the omentum, a few in the spleen and 
lungs, and microscopically in the liver and kidneys. 

The saccharomyces litogenes is present in large numbers in 
the lymphatic glands, but not as abundantly as the saccharo- 
myces neoformans under similar conditions of inoculation. 

The tissue reaction is marked, but the new cells resemble the 
fixed elements and there is no inflammatory reaction. 

This parasite is also pathogenic for white rats, rabbits, sheep, 
cattle, etc. The degenerated blastomyces are soluble iti mineral 
acids, without the escape of gas except in the case of nitric acid. 
No changes are produced by alkalies. 

To be CoaliiiUL-d. 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 
UNIVERSITY OF ILLINOIS. 

Editor, H. C. WADDLE, '03. ^Business Mgr. G. G. DOWDALL, '00 



Class Editors: 

H. B. HAMILTON, *00. CHAS. M. NOBLE, Ol. PAUL E. GRABOW, 02. 
GUY C. WAUFLE, '03. 



Faculty Departmetit, Dr. W. A. Fusey. Athletic Editor, A. DONKLE, '01. 

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EDITORIAL. 

With this issue, the entire editorial staff of tlie Plexus makes 
a complete change and it will be the purpose of the present staff 
to carry out the plan so well outlined by our predecessors, by 
making the Plexus a medium of exchange between the Faculty, 
on one hand and the alumni and students on the other. If you 
have made any discoveries in your research or desire to com- 
municate with our readers, send us your article and we will gladly 
give you space. We have met with a most hearty response to 
our invitation for articles for publication which is encouraging 
and which also goes to show the interest in the welfare of the 
Plexus. 

Our predecessor, H. J Stegemaun, has been compelled to 
leave school on account of ill health and has gone to Colorado to 
roam over the mountains in search of health and a second Klon 



204 The Plexus. 

dike. The Plexus wishes him a speedy recovery and success 

in locating the nuggets. 

It is with great pleasure that we present to our readers in 
this number of the Plexus, a letter from Dr. H. P. Newman, 
which was received too late for publication in September issue. 
We can assure our readers, however, that the letter has lost none 
of its interesting features by the delay of publication. 

Owing to error in printing in the September number of the 
Plexus, Dr. G. Frank Lyston was not given credit for his able 
and interesting article — The Passing of Dr. Sparrow. We are 
sorry the error escaped our notice. 

Our leading article of this number "Peritoneal Adhesions," 
by Dr. T. A. Davis, professor of Principles of Surgery, College 
of Physicians and Surgeons, is the first of a series of articles of 
which Dr. Davis is to present to our readers. We congratulate 
ourselves upon securing for our readers so able a man as Dr. 
D vis to present this line of work, as it is the first time the sub- 
ject of "Peritoneal Adhesions'" has been presented to the medical 
profession of the United States. 

With this issue a great many subscriptions are dae. If there 
is any doubt about your subscription write us. We are very de- 
sirous that you give this your immediate attention, and send the 
amount due to the business manager. 

The Plexus modestly though earnestly calls the attention 
of the State Board of Health to the lax manner among physicians 
giving death certificates by and through which the faith cure 
practioners, divine healers, Christian Scientists, and the thousand 
and one quacks, fakers, Adinfinitum, are enabled to cover up their 
criminal work, which if properly exposed would send many of 
the perpetrators to the penitentiary if not to the gallows. No 
doctor should be permitted to issue a death certificate in any case 
unless he was at the time of death and for at least twenty-four 
hours prior to the death in absolute control of the patient. The 
coroner should issue the death certificate in all cases not covered 
by the above conditions. 

Suppose a Christian Scientist or others, claiming to be 
healers of disease, were in addition to their humbuggery, to give 
the patient the needed medicine and cure the patient, would not 
such persons be amenable to the State law which requires all 
practicioners in Illinois to have a State license';:' Most assuredly 



Editorial. 205 

they would, and to claim that they can go unwhipped of justice 
simply because they do not give the needed medicine to save the 
life of the patient, and to be fined if they do. is neither law nor , 
common sense, the opinion of Attorney General Akin to the con- 
trary not withstanding. If the distinguished Attorney General 
of Illinois is himself not a Christian Scientist, it is charitable to 
his judgment to think that he is. 

Attorney General Akin of this vState, has rendered an opinion 
to the effect that there is no law in Illinois prohibiting the treat- 
ment of disease by mental or spiritual methods, by Christian 
Scientists or others, where no medicine is used, and that when a 
person dies for the lack of proper medicine under such treatment 
it is not an offense under the criminal code of Illinois. 

The law enacted by the last legislature requiring every one 
wishing to commence the practice of medicine in Illinois after 
July 1st, 1899, to first appear before the State Board of Health 
and pass an examination and receive a license before commencing 
to jjractice, is, to say the least, a very foolish law — It is more, it 
is an insult to the Faculty of every high grade medical college in 
Illinois. To say that such eminent i^hysicians and surgeons as 
comprise the Faculty of the College of Physicians and Surgeons, 
Chicago, Rush Medical College, and the Northwestern School of 
Medicine are not competent to pass upon the equipment of per- 
sons wishing to enter upon the practice of medicine, and that a 
body of men appointed by a Governor who often select them more 
oa account of what they did to help elect him, than for their 2:)ro- 
per qualifications for the place, is too fallacious to be considered 
by any intelligent body of men for one moment. 

The College of Physicians and Surgeons is a co-ordinate 
branch of the State University located at Campaign, The col- 
lege is a part and parcel of the State Institutions, the governor 
is by authority and power of his affair ex-officio chairman of the 
Board of Directors controlling these Institutions, and for the 
Legislature to say, or for the State Board of Health to say, that 
it is illegal an :1 that a person can be fined for practicing medicine 
while holding a diploma signed by the president of the State 
University, and the Faculty of the Medical College that the Gov- 
ernor is practically at the head of, is untenable. It will-be so de- 
cided by the Supreme C;)urt of the State when a test case is taken 
before ib, which will be done at no far distant day unless=the law 
is repealed by the next Legislature. The same will be the case 



206 Ihe Fle:(ns. 

with those holding- diplomas from Rush, the Northwestern or any- 
other reputable first class medical college in Illinois. It would 
be class legislation to say that the P. & S. because of being 
under the State Universit}^, could grant j^owers to graduates that 
the other high grade medical colleges could not grant. 

The law is wrong and ought to be repealed. Those enacting 
it may have meant well, but if they did. they fell far short of 
their good intentions, and the sooner they take steps looking to 
the repeal of the law and keeping it from the statute books, the 
better for all concerned. In case the Legislature wants to elevate 
the function of medicine and throw proper safe guards around 
the people, they can do so by enacting a law similar to the one 
enacted by the I'ast State Legislature of Michigan on that ques- 
tion restricting the State Board of Health from granting a per- 
mit to any one to commence the practice of medicine hereafter in 
the State unless the applicant holds a diploma from a high grade 
medical college. This would shut out the Christian Scientists, 
the faith healers, the quacks, the voodoo doctors and all those 
eminating from so called medical institutions, and make it 
possible for only well-equipped persons hereafter to commence 
the practice of medicine in Illinois. If this were done, those now 
holding a State license to practice medicine and who are incom- 
petent, will soon pass away after that has taken place. Then we 
all can point to the medical practitioners in Illinois as we can 
now to the other branches of the various lines of business within 
our borders. 

While a party of country doctors who were in attendance at 
t.ie Mississiijpi Valley Medical convention held in Chicago this 
month, were exchanging experiences, one of them said, "when I 
hung out my shingle in Jackson, Mississippi, and commenced the 
practice of medicine just after the war, at the end of four or five 
years I needed some money, and sent my bills through the mails. I 
continued this jn'oceedure for four or five years and did not receive 
any remittance even from one of my first, and I thought best pa- 
tients, at least I received more calls from his family than any 
other half dozen families I had. One day meeting him on the 
street, I asked hira when I might expect some money from him. 
He looked astonished at my question and replied, ' T don't know 
Doctor, I only called you in to patronize you and help you along 
because you were a young Doctor." 




KDWAUn. A. nsOHKIN. M. 1>. 



THE VALUE OF CLINICAL OBSERVATION OF 

SKIN-DISEASES FOR THE MEDICAL 

STUDENTS. 

By Edward A. Fischkin, M. D. 

Instructor in Dermatology College of Physicians and Surgeons. Assit-tant 

Professor of Dermatology, Northwestern University Womans' >!edlcal 

School. Attending- Dermatologist Norwegian Lutheran, Deaconess 

Hospital and United Hebrew Chrrities Dispensary. 

By nature of our intellect we obtain our knowledge of the 
outer world by classification and abstraction of the products of 
our observation. Objects are first to be observed, i. e., perceived 
by our senses, and by combining and comparing of the per- 
ceptions we build up our conceptions of things. Observation is, 
therefore, the source of all cognition and cognition the source of 
knowledge. Upon observation rests our rational -education. On 
the other hand, in the less natural education, that based on 
theory", the mind becomes filled with conceptions before there is 
any extended knowledge of the outer world. Life should later 
on furnish experience in their application. Hitherto they were 
erroneously applied, and therefore, things and men erronouesly 
judged, seen and treated. 

But if any education should have for its basis observ- 
ation and the training of the power of observation, it is espec- 
ially the case in medical education and instruction, for medicine 
is an empirical science par excellence, it originated in observ- 
ation and can only be practiced by one who is observing. 

Medicine is, therefore, the oldest of all sciences, because it 
began with the first prompting of man to observe, and since man 
and his physical ailments are closest to him, he was himself the 
first object of his observation. For the same reason the 
knowledge of external diseases, to which the eye was 
at first directed, was the first to develop. The old Bible 
tells us of eruption, itching, pustules and blisters, and the 
ancient Greeks recognized at first the diseases which ap- 
peal to the senses through the physical changes and ob- 
jective signs. Dermatology and surgery were, therefore the 
first known, whereas internal medicine was unknown in the 



20S The Plexus. 

ag'e of Homer. They treated eruptions in time of peace and 
healed wounds and extracted weapons of w^ar on the battlefied. 
They had to deal with diseases appealing to their eye and there- 
fore, they learned to observe, to see. The physician was 

'•The seer and the master of the human body, the helper in need.,' 
Only later with admission of the sick in the temples, in the 
so-called "Asklepicia'" and with the development of the art 
of healing by the specially trained priests, the sphere of phy - 
sicians broadened and symptoms of internal diseases began to be 
observed and comprehended. 

Even to-day obssrvation is the basis of medical training. 
The phj^sician must still be the "seer" and only through his 
power of inspection and observation is his successassured. The 
habit of looking and the habit of thinking and action are more 
closely related in medical work than anywhere else. 

The successful and famous practitioner possesses not only a 
greater knowledge but also a greater ability of inspection. Skene 
in his treatise on diseases of women illustrates this by a history 
of a case in hi^ own practice. A lady called to consult him re- 
garding her son, a little fellow, 7 years of age. After a brief 
survey of the patient he was able to tell the mother that the boy 
had recently had scarlatina and that when a child he had sore 
ej'^es, and tha this father had been subject to rheumatic pains in 
years gone by. The mother acknowledged that he was right in 
every particular. A glance at the boy showed that post-scarla- 
tinal exfoliation of the skin was still jDresent; the face was pale 
and puffy, showing post-scarlatinal nephritis. He also noticed 
that the bo}^ had a scar upon the cornea of each eye, the result 
of a former keratitis. The shape of his nose and the character 
of his teeth indicating congenital syphilis, and from the appear- 
ance of his mother and other facts known to him he presumed 
that the father was the one who transmitted the specific disease. 
Only through inspection and observation of diseases and pa- 
tients do we learn of the symptoms; learn to interpret their 
meaning; to differentiate between the important and the unim- 
portant, the stage and the severity of the disease, and according 
to this we outline our treatment. At the clinic only do we learn 
diagnosis and only at the clinic can we be trained in therapeutics. 
But no clinic is so well 'adapted for the training of the student, 
for the develojunent of his habit of inspection and his power of 
observation as the dermatological. Medicine owes its origin to 



Observatioii of Skin Diseases — tischkin. 209 

•dermatology and the physician should receive his first training 
in the study of skin diseases, in accordance with the biological 
law that the evolution of the individual passes through the same 
stages as the evolution of the human species. It is in the 
dermatological clinic that the student has the full chance and is 
■even compelled to learn to see, otherwise he would not be able 
to comprehend diseases of the skin and to understand their 
treatment. In the great variety of forms in which pathological 
processes appear on the skin he can only find himself at home 
when he is able to see every form in its true light, when his eye 
is trained to interpret the symptoms and to read their meaning, 
to mark the important and separate them from the unimportant 
and in this way, by interpreting and classifying, to make the 
diagnosis, i. e. to recognize the pathological process and the 
degree of its progress or regress. To illustrate: It is not suffi- 
cient to recognize eczema, it is also necessary to recognize the 
nature; and the degree of the eczematous process, and by its 
symptoms to ascertain whether it is acute, sub-acute or chronic 
whether superficial or deep seated, whether we have to deal 
with the effects of transudation and exudation or of hyperplasia 
and hyi^ertrophie of some of the skin layers and of which, 
whether each of his processes is in its incii)iency or is fully 
developed. 

It is necessary to interpret symptoms. It is not sufficient to 
notice the symptom of scaling in psoriasis, for instance, but it 
is necessary to form an ojoinion from the nature and shape of 
the scales as to the stage of the pathological process; the loose, 
grayish, falling of easily and quickly regenerated scales are 
signs of increased but not sufficiently hornified epithelial cells 
and are caused by an acute pathologic process, while the white, 
. dry, silvery scales that fall off' with difficulty^, point to prolifer- 
ation of less numerous but more perfectly hornified cells and 
point to a chronic pathological process. The treatment will 
■certainly have to be different in the chronic from what it is in 
the acute psoriasis. 

The diagnostic and therapeutic dexterity in dermatology 
rests upon the ability to see and understand symj)toms. General 
symptomotology should, therefore, be the first the student 
should learn in the clinic; it should be his preparatory training, 
as the training in the use of instruments and methods of 
-examination is preparatory to the other clinics, for observation 



210 PLEXUS. 

of symptoms is the only method of investigation and our eye- 
the only instrument of examination of skin diseases. It is not 
sufficient that the student recognizes an eruption as macular;, 
he should also note the shape and nature of the maculae on the 
pathological basis, for maculae may be produced by different- 
causes: through deposition of foreign bodies as in tatoo-marks, 
through deposition of pigment, as in freckles or chloasma, 
through alteration in the circulation of the vascular cutis as in 
hyperfemia. through alteration in the structure of the epidermis- 
and vascular cutis as in psoriasis, or through superficial fungoid 
layers as in tinea versicolor. But from the shape and nature of 
the lesion we can mostly come to understand the true patho- 
logical process. 

Papules may also have different causes; they may be pro- 
duced by (jedematous swelling as in urticaria, by inflammatory 
exudation as in acne, by hypertrophy of different layers of the 
skin as in psoriasis by retention of granular secretion as in 
Comedo or by granular formations as in syphilis. But the different, 
causes will communicate to the papule its nature and shape and 
vice versa from the latter we can draw conclusions as to the 
causing process. 

The oedematus papule (urticaria) has a bright pink areola, 
whose margins are ill defined, gradually shading off into the- 
healthy skin; the color disappears on pressure, the epidermis- 
retains its nitural furrows. The shape of the papule is hemis- 
pherical with a gradual slope. 

The exudative papule (acne) has a smooth surface, the- 
furrows disappeared and the shape is conical, pointed on the- 
summit. On pressure there will sometimes appear pus. 

The hypertrophic papule (psoriasis) is covered with scales, 
on whose removal we get a red surface with more pronounced 
furrows of the epidermis. The margins of the papule are well 
defined, the sides steep, and the top wide and flat. 

The neoplastic papule (syphilis) has a jDeculiar brown red 
(raw ham) color with distinct margins whose top is semispherical 
and often covered with light scales. 

The retention papule (comedo) has no special color, has a. 
point in the center through which the contents could be pressed 
out. 

General symptomatology is, therefore, of the greatest im- 
portance in dermatology and ^without it the majority of phy 



Observation of Skin Diseases — Fiscliliin. 211 

sicians will be unable to diagnose and treat skin diseases. It is 
to be regretted that most students are satisfied with the study of 
skin diseases from the books and acquire their knowledge in a 
theoretical way, as they are unqualified to cope with cases as - 
* they come to them in their practical work. They have accumu- 
lated conceptions unsubstantiated by observation. They try and 
fit their conceptions to the case and not possessing experience in 
the interpretation of symptoms they naturally fail. Here an 
illustration: A patient suftering Avitli tinea versicolor on his 
left leg presented himself to the dermatologist, giving the 
history of having been under the care of a physician who treated 
him for chronic eczema and gave him arsenic. This physician 
■evidently has not had sufficient experience with eczema to make 
a correct diagnosis of the case. He tried to apply a ready made 
conception derived from books, but to which the facts did not 
answer. 

The textbook reads: "Eczema is an acute or chronic 
inflammatory disease characterized by the appearence of ery- 
thema, papules, vesicles or pustules or a combination of these 
lesions terminating either in oozing with formation of crusts in 
absorption or desquamation."" The theorist who received this 
word picture, especially endowed with a vivid imagination, will 
easily apply this definition to almost every case. He is aware of 
the fact that it is not always necessary to have all the symptoms 
and as long as he finds a part he supplies the rest to complete 
the picture. He saw the brownish patch which he considered 
erythematous and the desquamation, and the diagnosis of eczema 
was made. But the j^ractical physician knows that nature 
makes no leaps and that erythema being the first stage and 
•desquamation the later stage of eczema, could not exist simul- 
taneously without the intermediate stages, without exudation 
and infiltration. He would observe the case more closely and 
would see that the patch is not erythematous, as there were no 
signs of inflammation present: The spot was brown, had sharp 
margins and did not disappear on pressure. He v;ould also 
notice that the scales were slight, furfuracrous and when scraped 
off with the nail there was a healthy epidermis behind tliem. 
The experienced practitioner would also examine the scales 
microscopically, if he has not already made the diagnosis and 
would have found the specific micro-organism, notwithstanding 
the unusual seat of the lesion. 



212 PLEXl^S. 

The fault of the physician was that he knew definitions and 
not diseases. 

"With still less logic and more zeal many physicians diagnose 
tinea versicolor as macular sypliilide. 

The clinical study of skin diseases is to the student not alone 
of practical import, developing his diagnostic and therapeutic 
abilities, it also enriches his theoretical knowledge and furnishes 
him with a concrete conception of general pathology of which he 
has otherwise an abstract and vague understanding. The patho- 
logical changes in the skin are accessible to sight and touch, and 
in this way many pathological processes known to us only theo- 
retically and in a limited way in the labaratory, appear to us 
more clear and are of additional value to us from the standpoint 
of general pathology. As an illustration we will take up the 
study of hyperamie and inflammation, and here again we meet ' 
the interesting phenomenon that the student in acquiring his 
knowledge passes through the same path scientific research trav- 
els through, to win the victories of science. The study of hyper- 
amie and inflammation owes to dermatology its origin and devel- 
opment, and it was on the skin, that the ancient Greeks recog- 
nized for the first time the four cardinal symptoms of inflamma- 
tion. Armed with the latest pathological conceptions, the mod- 
ern student is enabled to see plainly in the light of modern know- 
ledge the process of inflammation as it takes place in the skin. 

At the beginning of the inflammatory process we see diffuse 
patches of reddened skin gradually facing into the color of the 
surrounding normal skin. We see the epidermis unchanged and 
the red color glistening beneath the translucent epidermis. There 
is a determination of blood to the upj)er cutis, where a network of 
capillary blood vessels is spread. These are distended through 
the increased stream of blood, and the skin assumes a pink or red 
color, according to the extent and rapidity of the capillary blood 
current. In the beginning of the process the blood vessels are 
not yet distended to their utmost and the color is pinkish, but 
the hyperamie increases in the course of the process and the skin 
from pink, grows to be deep red. Simultaneously with the 
change in color there is a change in the shape of the erythema- 
tous patches. At the beginning the hyperamie spot is more dif- 
fuse with borders illy defined, gradually merging into the healthy 
skin. This is due to the fact, that the blood rushes to the cen- 
ter, the seat of inflammatory irritation, and the farther from this- 



()hscrv\(tton ef'Skiii Diseaies—FiacIiL-in. 213 

center the less is the determination. But as the hyperamie de- 
creases the border becomes more distinct and sharply outlined 
because the capillaries in the center of irritation are getting more 
and more distended, and thus release the capillaries of the sur- - 
rounding j^ortion of the skin, which now return to their normal 
state. We are sure, that in the process of hyperamie the blood 
is within the blood vessel walls, because by pressure we can ren- 
der the hyperamie area anaemic. But as the inflammatory pro- 
cess goes on, the blood vessel walls become altered and serum 
exudes into the upper cutis, which becomes infiltrated; the previ- 
ously erythematous area becomes now swollen and we can see 
add feel the wheal or oedematous papule. 

The epidermis is still unaltered, the effusion of serum must 
have taken place in the cutis. The color of the papule, especial- 
ly the erea surrounding it, is still erythematous, but gradually 
the centre fades, the oedematous infiltration pressing out the 
blood from the capillaries. The margins of the papules become 
more distinctly defined. 

As the inflammatory ] recess comes to an end, the exuded 
serum is gradually absorbed and the papule diminishes and disa- 
pears. But where the effusion of serum still continues it either 
penetrates in the structure of the epidermis and destroys it, gain- 
ing exit to the surface of the skin, or were the epidermis is of 
high resistance it lifts it up from the cutis and forms a vesicle 
i. e. an elevation of the epidermis containing clear serum. If the 
process ends at this stage the disturbance can still have a favor- 
able termination, the serum is absorbed and the skin returns to 
its normal state. But when the inflammatory irritation still con- 
tinues we can trace for ourselves the process of exudation, dis- 
covered by Conheim. We see the clear vesicle getting opaque 
and turbid, and soon fill with pus. The blood vessel walls have 
lost their tonicity, and the white blood cells have escaped into 
the surrounding tissue, accumulated in the vesicle, and rendered 
it into a pustule. 

As in inflammation we can from observation of other skin 
lesions (hypertrophic, atrophic, necrosis etc.,) gain help in our 
understanding of pathological processes and enrich our know- 
ledge of general pathologie. 

Finally there is another and not less important benefit for 
the student in clinical observation of skin diseases, and that is. 
the acquirement of most necessary means of protecting himself 



'2U PLEXITES. 

as^aiust accidenz and professional martyrdom in his future prac- 
tice. It is well known that no small number of physicians fall a 
sacrifice to their profession in the examination and treatment of 
jDatients afflicted with syphilis, they become infected with this 
horrible disease. Chancre of the fingers is known as profession- 
al syphilis, because in examinations, especially gynecological 
and in obstetrical and surgical practice, the fingers of the physi- 
cian are more liable to come in contact with the blood and muc- 
•ous discharge of the patients and become inoculated with the 
•syphilitic virus. In Fournier's statistics of .forty-nine cases of 
digital chancre, thirty occured among physicians, and Prince A. 
Morrow has observed thirty-two cases of extragenital chancres of 
which twelve were digital chancres of physicians. Professional 
syphilis," says P. H. Morrow, is much more common than is gen- 
erally supposed, and for obvious reasons. Syphilis is not a dis- 
ease, which reflects credit upon its possessor, and the unfortu- 
nate victim is not eager to i^roclaim himself a syphilitic. ^ 

Forewarned is forearmed, and the recognition of the danger 
would lead to greater care in the protection of the fingers and 
•greater circumspection not only in the examination of known 
syphilitics, but of patients of whose history and antecedents noth- 
ing is known. It is a note-worthy fact that specialists in venere- 
al diseases, who are most exposed to constant contact with syph- 
ilis, are rarely contaminated. This is because they recognize the 
•danger and take greater precautions to guard against infection. 

Whoever has seen physicians, who in the fullfillmentof their 
■duty have had the misfortune to infect themselves with syphilis 
and has seen their terrible anguish and their despair bordering 
on insanity, knows what a frightful disease syphilis is to a phy- 
sician, and will deal otherwise with his syphilitic patients or 
those, whom he can suspect to have syphilis. 

One should be impressed with the sublime and noble ]')hiian- 
tropy and the self-sacrificing duty of our ideal profession, but 
when he has seen an unfortunate colleague with "syphilis inson- 
tium", he will come to the conclusion, that the life of a physician 
is of more value to himself and to society, than the poisoned life 
of a dozen miserable syphilitics. And whoever is concious of 
this will in his own interests and in the interests of those near 
and dear to him, endeavor by observation and clinical study, to 
learn the symptoms of syphilis and of skin diseases in general. 



LETTER FROM PROF. NEWMAN. 

■ To the editor of the Plexus. 

If I were obliged to spend the rest of my days away from 
America — an impossible supposition — no place would seem to me 
so attractive and homelike as Paris. London is mighty and 
magnificent; Berlin heavy and handsome; but for American 
lungs give me the atmosphere of a republic. 

It is impossible not to feel at home in this thrifty, noisy, en- 
thusiastic home of independence, especially for a Chicagoan. 
The city is not unlike our city in many ways, and the people are 
not unlike our people. Speaking quite personally and within the 
circle of my own profession, I cannot say too much in favor of 
the Frenchman as a j^hysician. This visit to Paris more than 
any previous, has brought me into intimate contact with many of 
the fraternity. 

I have been here about a month now, and although it is at a 

time when most of the busiest men are taking their annual rest, 

I have been given many opportunities to see good work and have 

been shown every possible courtesy, personal and professional. 

\ I have made almost daily visits to all the hospitals of note and 

' have spent the morning in one or other of the greater clinics. 

The Paris doctor has very comfortable hours for work, at 
least at this season. He is busy in the clinic from nine or ten till 
' twelve, and free for the rest of the day. Then he is very exclu- 
sive in his mode of life. I should say rather, seclusive, since I 

■ refer only to his manner of announcing himself to his patients. 
It is only the "little doctors," they tell me, who allow themselves 

• the publicity of a sign at the door. There must be very few who 

: are willing to be placed in this class for I have seeii a physician's 

--sign — small and inconspicuous at that — in very rare instances. 

This fashion has its disadvantages. You are obliged to hunt 

your doctor often in a large apartment building occupied by many 

" people. The doors are all alike — no name-plates or anything — 

and you may ring several wrong bells before you find the right 

< one. However, custom is a severe master, and I suppose it is 

. difficult to cut the first string of ethical red tape. 

The professor sits while lecturing, which makes the hour 
.quite informal and conversational. The laboratories are well 



equipped and have abundance of material. The clinical material 
is also plentiful. I saw upward of three hundred and fifty cases 
run through in a morning in the skin clinic at the Hospital St. 
Louis. 

For another thing, the medical man is much respected in the 
community. In the public institutions clinics and wards are 
named for some well known j^hysician and the man who has given 
his life work to hospital and dispensary does not necessarily ef- 
face himself thereby. The tricolored flag of France floats over 
the Bandelocque and Tarnier Clinics, the Pasteur Institute and 
Pean Hospital and many similar monuments to the labors of good 
men and true. 

The clinics which I have visited most often have been Dupley's, 
at Hotel-Dieu: Richelieu's, at Hopital St. Louis; Albarron's, Hopi- 
tal Necker; Tuffiier"s, at the Lariboissiere; Faure's, at Charite^; 
Profs. Segond, Pozzi and Bouilly at the Saltpetriere, Broca, and 
Cochin hosi^itals . 

The three latter men are taking vacations at present and so 
I have not had the pleasure of seeing them at work, but I have 
met them professionally and enjoyed them exceedingly. Dr. 
Segond, who has a warm feeling for Americans as a result of his 
trip to our continent some four years ago, has been excei^tioually 
kind, and I have received many courtesies from him and his friend 
Dr. Paul Muller.* 

In general I have remarked that the French physician is not 
only courteous to his colleagues but kind and considerate to his 
patients. 

I cannot help thinking that this spirit of sympathy and hu- 
manity is the outgrowth of republican soil. At least I have not 
found it so well developed in other European countries. 

Then the Frenchman is a deft and skillful operator, cool and 
capable, notwithstanding the national reputation for nervous 
excitability. 

This characteristic is shown also by the jiatient who endures 
supreme physical ordeals with little evidence of shcck or depres- 
sion. In the clinic at Hotel-Dieu the other day. Dr. Delbet, sur- 
geon, I saw an operation for cancer of the pylorus, in the course 
of which the operator removed nearly two- thirds of the stomach 
and a portion of the intestine quite as a routine proceedure and 
without exciting any particular comment among the onlookers. 

* T)r. Muller is a ^ood f ripiid to Americans in Paris and has loolied after the health 

of some of our IjL-st (;iti>;cns in tlieir sojoiji ns aljroad. 



Letter from t)r. Neicman. 217 

In this proceedure he used no fancy stitching or appliances, only 
two rows of continuous catgut sutures. And a few days before I 
had seen the same operator at w^ork upon a ghastly case of caticer 
of the intestine under the most trying circumstances. The tumor 
had been diagnosed as a large pyosalpinx and hysterectomy had 
been done before the true condition of things appeared. The 
operation was continued, however, with the necessary extensive 
cutting and removal of large portions of intestine. 

I saw the patient on the next day, not only alive but looking 
quite comfortable in her neat bed. 

The Parisian love for the beautiful and artistic is manifested 
in the furnishings and adornment of hospital and dispensary 
quite as noticeably as in the palaces and boulevards. The wards 
are bright and inviting and the waiting rooms often enlivened 
with frescoes and floral decorations. Like all buildings in Paris 
the hospitals have the large inner court, and this is almost uni- 
versally well filled with handsome plants. 

I want to say just a word about the position of the foreign 
poj)ulation in Paris. 

There is in force here such an extreme protective policy that 
overcrowding of the profession is effectually prevented. The 
university degree which one is free to take here, does not entitle 
one to ]3ractice in Prance, and the examination necessary for a 
certificate is not open to foreigners. 

I am told, however, that exceptions are sometimes made in 
the case of those who can secure a proper amount of "influence," 
that bane of all republics 

There is much reason in this exclusiveness, however, as Paris 
is so cosmopolitan that without it the ranks of the profession 
would soon be over-run. It is not to criticise them that I speak 
of it, but to call attention to the attitude of our country in the 
premises. It need not, I think, be narrowness, but a just degree 
of self respect that should prevent us from welcoming with such 
effusive warmth every foreigner who comes to us from Heidel- 
berg, or Leipsic or Bonn or Paris, in medicine, literature, lan- 
guage or music We should not receive so tamely the slight put 
upon our great American universities whose honorable degrees 
are not recognized or credited abroad. Just a little bit of healthy 
reciprocity, ever so good natured, would wake up this self-satis- 
fied Old World to the worth and merit of the New. 

A letter from Paris without any reference to the three great 



218 PLEXUS. 

exhibitions she is making for the world, at Rennes, at Rue 
Chabrol and on the banks of the Seine, would be empty reading. 
So I must add that Dreyfus and Jules Guerin are greater 
heroes outside of France than here in this big, bustling metropo- 
lis. It is such a sad thing for the country and the better people 
in the army and out of it, this travesty of military justice, that 
the best French sentiment tries to cover the wound from foreign 
ej^es; and the absurd incompetence of the civil authorities in the 
case of the Anti Semitic League self-imprisoned in Monsieur 
Guerin's -'Fort,'" is a matter of grave chagrin to the Parisian. 
As for the Exposition of nineteenth century i^rogress which is to 
be held here the coming year, it w^ill certainly serve to re-estab- 
lish the fame of the city after these trying times are over. The 
buildings are well under way, the situation is lovely and from all 
one can hear and see, the Exposition of 1900 will surpass in effect 
anything before attempted in this world of shows. After 
America's splendid exploit at Chicago, she will not be jealous of 
this success. Her example has made it necessary; her money is 
making it possible, and her people will come to see it all and go 
away saying as they always do: "There is no city on earth 
quite like Paris. "" 

Paris. France. Septembers, IS'.iy. 



CLINICAL DEPARTMENT. 
E. A. Gansel. 

College of Physicians and Surgeons. 

As the college work for the new year began on a Wednesday 
the schedule called for Prof. Harsha to present the first clinic to 
the incoming senior class, and the class was not disappointed for 
with his usual promptness, Prof. Harsha was ready to begin his 
work by presenting a number of inceresting cases. Many of the 
cases Avere interesting because they were of such a character as 
many of the class are expecting to take care of themselves, be- 
fore the next twelve months have passed. Among the rarer 
cases operated upon in this clinic, was a resection of part of the 
fifth nerve for tic dculoureux, and a removal of part of the palmer 
fascia for Dupuytren's Contraction. 

Under the energetic supervision of Prof. Butler, the members 
of the present senior class will be given a course in general med- 
ical diagnosis and bedside instruction superior to that received by 
any previous class graduating from the P. & S. and at the same 
time a course which will certainly not stand second to that given 
by any other medical college in Chicago during the coming year. 
Prof. Butler with six competent assistants will conduct this, bed- 
side instruction at Cook County Hospital throughout the year. 
In this work each assistant will have charge of but eight men at 
a time, thus giving him an excellent opportunity to give individ- 
ual attention and aid to each student in his section. Under this 
plan there will be no less than forty-eight students receiving ac- 
tive bedside instruction every week, and this further means that 
every member of the senior class will obtain about two months of 
this line of work before he finishes his course. The students who 
have already begun this work speak of it in the highest terms 
and there is no doubt but that the others will do likewise as soon 
as they are given the opportunity to see the intensely practical 
nature of this way of studying pathological conditions. 

Aside from the above work Prof. Butler will continue his 
general climes in which he always manages to give the students 
a number of valuable points on practical therapeutics. 

To be present at any of Prof. Murphy's clinics means to be 
interested in the work that he is presenting, for no matter what 



220 PLEXUS. 

the nature of the case may be his clear explanation of the condi- 
tions present, together with an occasional question such as, 
"What is the matter with him":'" tend to hold the attention and in- 
terest even of those students who at other times often allow their 
minds to wander to subjects far remote from what the lecturer is 
trj'ing to present. Besides himself presenting a large variety of 
iateresting cases, Prof. Murphy has given several of his clinic 
hours during the past month. Three of his colleagues from out 
of the city, thus giving to the class an opportunity of seeing and 
hearing three of the great surgeons of the Western Continent. 
They were Prof. Cordier of Kansas City, Sir James Grant of Ot- 
towa, Canada, and Dr. Rafil Laviste of the City of Mexico. 

Prof. Steele's clinics are in the truest sense of the word 
"students" clinics." He believes that the students should take a 
direct and personal interest in the cases, and for that reason al- 
lows them to take an active joart in every new case that presents 
itself for treatment at these clinics. As the patients arrive they 
are assigned to students in alphabetical order. The student when 
assigned to a case is given ample time to write up the history, 
make a physical examination, and therefrom decide upon the di- 
agnosis as well as come to some conclusion on the best treatment 
for the ca?e, as it presents itself. Patient and student then come 
before the clinic and the latter reads the history, gives his diag- 
nosis and outlines what he considers the proper treatment. 

Further examination is now made and if the student has 
made any errors he is corrected at this time. The patient is then 
treated, the student at the same time noting on his history sheet 
each step of the treatment. All histories are preserved and can 
thus be referred to at any future clinic. This plan of work throws 
the student on his own resources and most closely approaches 
the kind of work that he will have to do after leaving college. 
Prof. Steele's wide experience undoubtedly has brought him in 
contact with many errors made by young practitioners and he is 
therefore giving us such a training as will spare us many humil- 
iating errors when we can no longer have his guide and counsel. 



CLASS NOTKS. 

SENIOR NOTES. 

It is with a certain degree of fear and trembling that we 
make our bow as writer of the senior notes. The excellence of 
our predecessors impresse's us with our own unworthiness and 
s*:imulates a longing for "better days." We start out on the 
basic principle of "Charity for all and malice toward none," and 
with a firm belief in Republican reciprocity we demand an en- 
forcement in this line with a ratio of 16 to 1. 
The senior class numbers 140. 

Dr. Earle supplemented his excellent cause in obstetrics by 
a practical demonstration in the clinical amphi-theater the morn- 
ing of the 18th. It was a boy. 

Birklund seems to have especially enjoyed his maternity 
work . 

The charms ol the class of 1900 have been materially in- 
creased by the addition of several members of the gentler sex. 
Anyone desiring furthur information can find the same by seeing 
Avery, Miller, Meaney or Helm in the order named. 

The slight disturbance at the left upper door of the amphi- 
theater during Dr. Murphy's clinic, was caused by the sudden 
anemia in a D. J.'s brain produced by his first visit to a clinic. 

On account of excessive modesty McCormick declined to act 
as interpreter. 

P. & S. secured her share of recognition during the Pall Pes- 
tival. Dr. Ling was prominent among the Chinese aggregation 
a,nd reports honors of which the college should be proud. A 
member of the senior class led the McKinley procession and was 
greeted throughout the whole march with the plaudits of an ap- 
preciative crowd. D. A. Turner chaperoned the ladies of the col- 
lege and wnth his usual degree of grace and sagacity showed them 
a "delightful time '" and proved that he is no novice. 

An unreliable notice of an obstetrical case was the explana- 
tion of an unusually large attendance on Dr. Steele's clinic Mon- 
day. Preshmen are always enthusiastic obstetricians. 

It seems that Dr. Dowie made some remarks that Parsons 
doesn't like. Parsons says he isn't "flush" but he will furnish 
one case of eggs at least. 



222 THE PLEXUS. 

Mrs. Helm didn't respond to Dr. King's roll call. 

••Grandma's" sitting down act reminds one of the sudden 
breaking of the cable of the Halsted street lift bridge. 

We are pleased to note the progressive spirit displayed by 
some of the members of the class in lines other than professional- 
Mr. Hyde thinking to halve his sorrows and double his joys, dur- 
ing the summer assumed martial obligations and now declares 
independence of landladies, boarding houses, etc. 1900 doffs 
his (y) cap and congratulates. 

Podstata says he can spell his name if he just has a little 
time to think. 

Daily the wonders of science are revealed to her explorers^ 
Sometime the reward of years of untiring effort in seemingly un- 
profitable fields; at other times by a fortunate touch the con- 
scientious observer is startled by the almost ansought glimpses 
into the mysteries of nature which suddenly flash upon liim. Dr. 
Theodore West accidentally made the discovery that collodion is- 
of more value as an anasthetic than ether alone. The doctor 
claims that coUodian forms a cuating over the respiratory and 
other tracts, and in this way does aw^ay with the initating affects 
on mucous membranes. The coating also admits of a less rapid 
absorbtion and consequently a more regular and less dangerous 
anesthesia. Verily science is progressing. 

.lUNIOR NOTES. 

The officers elected for the ensuing year are as follows:. 
Harry W. How^ard, Pres. ; LeRoy J. Holmberg, Vice Pres ; Jos^ 
Zabokrtsky, Treas. ; Edward L. Heintz, Sec'y; Chas. M. Noble^ 
Editor. 

The committees have not as yet been appointed. 

The Junior class was well represented at the opening meet- 
ing of the Medical society, comprising at least two-thirds of those- 
present. 

Dr. Carl Beck looked very much disturbed (mentally) ^AheTl: 
he found himself confronted by a large class of Juniors. We did 
not suppose that he would forget us so soon, 1mm! 

''Dewey looks like me ! " 

The Glee and Mandolin Club elected the following officersr. 
George A. Colburn, Business Manager; Andrew J. Ames, Leader 
of Glee Club, both of which are of our class. 

The class has about one hundred and forty on the role and it 
is still increasing. 



Cf<i.^s Notes. 223 

Saegaard did not go to Europe. 

A weekly indulgence of "Lemkes" "Burr" combined with a 
small amount of "Porter," should make us quite "Hardy" and in 
time convert us into a "Newman," without the customary 
"Brown" colored taste remaining. 

Dr. Harsha evidently thinks we look like Seniors, while Dr. 
Beck takes us for Soph's. But when Dr. Murphy strikes us in a. 
quiz he makes some of us feel like "D. J.'s." 

A remarkable case of fracture in two places is reported by 
Dr. Smoke, of Pipeville, N. G., one of which occurred in upper 
third of the tibia and the other in the backyard. 

Did you hear the Y. M. C. A. quartet"? If you did you will 
agree with me that they at least sang the same piece. 

It is quite evident that Cameron, is wearing a larger size in 
hats this year. Too bad for one so young. 

A couple of days after college opened "one of the boys" sent 
a letter home as follow: 

Dear Dad : 

If you love me as I love thee, 

I think you would send me a 50 — See. 

And in return he received: 

The rose is red, the thistle pink 
I'll send you a 50 — I don't think. 

The above resembled Willie Dodson's writing very much. 

SOPHOMORE NOTES. 

After a good many hand shakes, and ' 'Hello old man what 
have you been doing ?" the sophomores are again pursuing the 
even tenor of their way. 

Ever since Prof. Sherwood exploded, "Iter a tertio ad 
quartum ventricuium." — P'Gad has been two inches shorter and 
French tries to keep awake. 

There was an incipient board of trade riot in L. A. the other 
day. — It happened like this: Miller got next, then Lunn came a 
close second. Bidding went fast and high; when the call for 
margins came, Miller was passed up and Lunn returned to his 
old love, but the smile of the co-ed haunts him still. 

Prof. Evans: Now, Mr. Sabin, how could you produce an 
inflammation on the person of another? 

Mr. Sabin: I'd-soak-him-one. 

Wanted — A capable young man to succeed me as runner 



224 PLEXUS. 

around the table, and yell "Eveiy body out/" when the Profs 

are late.— C. A. Phifer. 

Dear fellow students: As I am now in busmess with Mr. 
Moses Levi. I humbly solicit your trade. We buy any old cloth- 
inir; socks, hats, coats and rags. Yours for cast off clothing 

C. Abraham Inks. 
A pronouncing dictionary for Profs. 
Low pronounced to rhyme with cow, how. 
Slyster pronounced to rhyme with Shyster. 
Kaa pronounced to rhyme with hay, day. 
The class is grieved to note absence of Mr. H. J. Stegeman, 
is travelling in the west for the purpose of recovering his health. 
Hard work with no exercise may in a measure, account for his 
ill health. We wish him a speedy recovery and return to his 
class. 

The Sophomore class can be found, and justly so. It is the 
back bone of the Glee Club, the main stay of the Mandolin Club, 
the bone, sinue and brains of the foot-ball team. It is the only 
class that has rooterf< to help the boys, and last but not least, it 
has a deacon and a chaplain. 

They say there is a Sophomore 

And he is wondrous wise; 
Twelve inches is his hair or more 
And dark brown are his eyes. 

His shirt is blue, his collar green 

A tie like tire aglow: 
In rain or shine, he's always seen 

Top most uix)n the row. 

I. S. Malaprop Brown: — An astringency of a man's financial 
equilibrium may abridge, as it were, his ability to reimburse the 
larder, as it were, with such necessities of his physical economy 
as are prerequisite to continue his corporeal existence in a 
manner conductive to health and happiness. 

FKESHMA]N NOTES. 

At a meeting of the Freshmen class the following officers 
were elected : 

W. T. Barnum, Pres. ; P. H. Holmes, Vice Pres. ; Miss Clara 
Dunn, Sec'y; J. A. Rolfe, Treas.; Guy C. Waulle, Class Editor. 

The President ai)pointed as the Executive Committee, M. E. 
McGhann, Mr. and Mrs. B. Thomas and N. A. Moore. 

The cla.ss of 1903 numbers ll'.». 



Class Notes. 225 

The Freshman class of the present year is an unusually large 
one and the members are lacking neither in physical nor in- 
tellectual development. Such being the case it is to be hoped 
that we will use our physical powers in the support of our intel- 
lect instead of trying to see how much more damage we can do 
to some other fellow's face than he can do to ours. 

The advance classes are in a position to assist us in many 
ways, individually and collectively, and we should endeavor to 
cultivate their friendship and good will. 

The D. J. 's have enrolled a very noble personage — Oscar 
Wilde. Mr. Wilde is making ostoelogy a specialty. Mr. Laben 
specialist on bones, exchanged cards with the versatile gentle- 
man at a quizz last week. It is hoped that in this friendship the 
freshmen have a neucleous for the formation of a mutual admira- 
tion society. 

One of our number seems to think it his duty to address the 
class once a week. 

Meloy and Shoop wear new hats since the Freshman and 
Junior push. 

He who knows not and knows that he knows not is worthy to 
be called ' 'a Freshman. '" There are a few however wlio properly 
belong to the Junior class, they who know not and know not that 
they know not. 



LIBRARY NOTES. 

Grace W. Bryant, Librarian. 

The good friend of the Library, Dr. Quine, has again remem- 
bered us with a munificent gift of about a hundred volumes. 
Among these is a complete set of Ziemssen's "Cyclopaedia of the 
Practice of Medicine'' in twenty volumes, and twenty other vol- 
umes on practice. A nearly complete list will be found in next issue 
of the Plexus. Among these are many volumes we have greatly 
needed, and Dr. Quine has the thanks and appreciation of the 
large number of readers of the Library. 

Dr. Harsha brought us a much needed volume, "Zucker- 
liandl's Operative Surgery;" and also Wharton's "Minor Surgery 
and Bandaging." 

Wm. Wood Co. sent us a complimentary copy of "Rose and 
■Carless' Surgery." This has proved a great boon to the Juniors 
while waiting for the next edition to come out. 



226 THE PLEXUS. 

Our new reading- tables ad.I much to the comfort and appear- 
ance of the Library, and have received hearty commendation 
from the students. The Library is used more and more each 
Aveek, averaging an attendance of over a hundred a day. One 
day the attendance numbered 163, the highest record in the his- 
tory of the Library. 

Our newly bound journals are now in their places on the 
shelves ready for Senior reference work. We now have com- 
plete files of the N. Y. Medical Rtcxivd, Joiirnal of A. M. A., Chicago 
Med. Recorder, Chicago Clinical Review. We hope through our sys- 
tem of exchanging duplicates to complete several other files be- 
fore next summer. 

The following articles from members of the Faculty have 
been noted in the journals during the last mouth: 

Dr. G. F. Butler. — "Physiological Action and 'Therapeutics 
of Guaiamar, a Derivative of Guaiacol,"' iV. Y. Med. Jour., Sept. 
23, 1899, pp. 438-42. 

Dr. T. A. Davis. — "Case of Fracture of the Shaft of the 
Radius of the Upper and Middle Thirds," Chicago Clinic, Aug. 
1899, pp. 313-15. 

Dr. W. T. Eckley. — "Dislocations of the Femur," Chicago 
Clinic, Aug. 1899, pp. 305-11. 

Dr. A. F. Lemke. — "Report of Cases of Pulmonary Tubercu- 
losis, treated with intra-pleural injections of nitrogen, with a 
consideration of the pathology of compression of a tuberculous 
lung." (Read at the 50th annual meeting of A. M. A., Columbus. 
Ohio, June, 1899). Journal A. M. A., Oct. 14, 1899, pp. 959-63. 



ALUMNI NOTES. 

The notes for this issue deal with the class of 1898. 

The following gentlemen have responded to the request for 
information concerning themselves. 

"98. C. S. Hutchinson, of Ames, Iowa, visited the Plexus 
oifice recently. He was on his way to see the sights of New 
York. One of the contemplated incidents of his trip was the- 
taking of a wife. 

Dr. Hutchinson is Prof, of Physiology and of Ophthal mologj^ 
in the Iowa state college. 

"98. David G. Wells, McHenry, 111. Dr. Wells has recently 
bought a valuable corner on which he will build next spring. 

"98. L. G. Witherspoon — Westside hospital. Dr. Wither 



Alumni. 227 

spoon is just finishing his services in the liospital. 

'98. W- T. Stone, Park Rapids, Minn. 

"98. W. A. Purington, Sangerville, Maine. 

'98. A. U. Puson, 728 N. Edison St., Stoclvton, Cal. 

'98. L. L. Cahill, Elizabethtown, New Mexico. 

'98. E. D. Whitney, Painesville, Ohio. 

'98. T. U. McManus, Dunkertown, Iowa. 

'98. B. T. Stevenson, Harvey, 111. 

'98. Wm. Sherin, 45 Stanley Terrace, Chicago. 

'98. P. S. Scholes, Canton, 111. 

'98. F. D. Pratz, Moweaqua, 111. 

'98. J. F. Corbin, Galesburg, 111. 

'98. P. Kalaczinski, 638 Noble St., Chicago. 

'98. S. R. Petrowicz, Milwaukee Avenue and Division St., 
'Chicago. 

'98. A. E. Kohler, Mopne, 111. 

'98. B. F. Flanagan, 711 W. 43, Chicago. 

'98. W. T- Dowdall, 3026 Prairie Av., Chicago. 

'98. A. C. Crofton, Pasadena, Cal. 

'98. E. M. Beyers, Belvidere, 111. 

'98. D. A. T. Bjorkman, 605 Main St., Evanston, 111. 

'98. W. Petersmeyer, Odebolt, Iowa. 

'98. Jas. M. Nefe, Cook County Hospital. 

The following graduates have not responded. Their names 
'have been taken from the address book of the Plexus. 

'98. W. S. Bebb, Hinsdale, III. Dr. Bebb has just finished 
-his service at the West Side Hospital. 

'98. Wm. Belitz, Cochrane, Wis. 

'98. M. A. Bingley, 241 Milwaukee Av., Chicago. 

'98. F. H. Blaney, West Side Hospital, Chicago. 

'98. W. F. Brownell, New London, Wis. 

'98. J. B. Butts, 474 Ogden Av., Chicago. 

'98. F, H. Conner, Nevada, Iowa. 

'98. F. S. Feeny, New Hampton, Iowa. 

'98. G. J. Fleming, Cook County Hospital, Chicago. 

'98. M. S. Fletcher, Jamaica, 111. 

'98. S. C. Garber, Camden, Ark. 

'98. J. W. Garth, Clarion, Iowa. 

'98. Wm. Hall, Millersburg, Md. 

'98. Eunice B. Hamill, DesMoines, Iowa. 

"'98. W. E. Hart, 22d street and Wabash ave, Chicage. 



22* PLEXUS. 

"98, E. A. Hunt, Independence, Iowa. 

"98. C. E. Husk, Tapazola, Mexico. 

■98. J. G. Wuerth, 35th street and Rhodes ave, Chicaa. 

•98. G. V. Wyland, Marcellus, Mich. 

"98. C. J. Wynekoop, 1503 Addison ave, Chicago. 

'98. H. C. Rogers, Pringhor, Iowa. 

"98. C. F. Stotz, 49 W. Randolph street, Chicago. 

"98. C. D. Stone, 2220 Calumet ave, Chicago. 

"98. H. J. Swink, 4301 Easton ave, St. Louis. 

'98. J. S. Nagle, Harrison street and Western ave, Chicago.. 

"98. A. C. Page, Cook County Hospital. 

'98. O. H. Pagleson, Cook County Hospital. 

"98. J. S. Phillips, 60th and Butler streets, Chicago. 

"98. C. B. King, 390 N. Clark street, Chicago. 

"98. E. C. Knight, 96 State street. Chicago. 

"98. F. B. Lucas, Peoria, 111. 

The first returns from the assistant secretaries came from 
Dr. E. E. Maxey, of Caldwell, Idaho, secretary of the class of 
1891. — It is to be hoped that we will soon hear from those secre- 
taries who have not sent in their reports. 



NEWS ITEMS. 



Your subscription is now due. 

Dr. G. Frank Lyston has returned from his eastern trip. He 
was operated upon for appendecitis at the Post Graduate Hospi- 
tal, New York, and afterwards went to Florida to recuperate. 

The Plexus enjoyed a visit from Dr. Charles Stoltz, of 
South Bend, Ind. Dr. Stoltz is class secretary of the class of 
'93, and shows quite an interest in his work. 

From LaSalle Tribune of Oct. 4, we copy the following con- 
cerning Dr. R. M. Sterrett, of the class of '90. "Dr. Robert M. 
Sterrett, of this city, has received word of the acceptance by 
Mrs. Jessie Bartlett Davis, the famous prima donna, of his new 
opera, 'Siegfried or the Silver Cup.' It will be a three act piece 
largely romantic in its nature." "It will be first ijresented, it is 
thought, by Mr. Sterrett in Chicago in the latter j^art of 
January." 

Splendid location in South Chicago for a good dentist. 
Suite of rooms in building occupied by i:)hysician and surgeon. 
Address X. Y. , this office. 



ATHLETICS. 
CHICAGO WINS BY A SMALL SCORE— SCORE 12-0. 

BOTH TEAMS PLAY A SPEEDY GAME. 

The college of P. & S. opened up with their first game of foot 
ball against the strong eleven of Chicago, Sept. 30, it taking ten 
minutes to score the 1st touch down. Kennedy kicked off to 
Dowdall, who was downed by Sheldon on the 35 yard line. Flip- 
2)en and Comstock each made 3 yards plunges through center, 
then Chicago took the ball for holding, A fumble gave P. & S. 
the ball again and Major punted. Hamill muffed the ball and a 
P. & S. man fell on it. For holding in the line Chicago was 
again given the ball 40 yards from goal. At this point Slaker 
began plunging and stopped only when he lay with the ball 
across the P. & S. goal. In traveling the distance he carried the 
ball in 14 out of 17 plays. When inside the five yard line Do ,^- 
dall was ordered off for some unknown reason. Donkle replaced 
him. At this point P. & S. did some very pretty work and made 
a desperate stand under their goal posts and the Varsity was 
forced to take three trials to gain the final 4 yards. Kennedy 
kicked a straight goal. 

After 2nd kick off by Capt. Majors, \vell to the right of the 
field the tall half back cleared the line between splendid intefer- 
ence by Slaker , Henry, Kennedy, Milington and Sheldon. He 
barely escaped Flippin who made a most elegant attempt but 
missed. With the entire team racing to cut him off on the left 
side of the field, Hamill suddenly wheeled to the right and gained 
the goal line. The play was made in one minute and forty sec- 
onds after second kickoff. After this touchdown P. & S. took a 
brace and little gains were made either way . 

Capt. Major kicked off, and after a few successive plays. 
P. & S. gave the Varsity a bad scare in second half. Fumbling 
and holding in the line gave P. & S. the ball on the Varsity 
twenty-five yard line, where they began to play rapidly for a 
touchdown. They gained ten yards in three downs before the 
Varsity lined up. On the ten-yard line Speed came to the rescue 
and by a fine tackle stopped Plippen on the third down with a 
yard to go. Fumbling again spoiled chances for scoring by the 
Varsity men. Hamill made a mess of two high punts and Ken- 



230 PLEXUS. 

uecly let another escape. Each time a P. & S. man dropped on 
the ball. At this stage McCormick, of P. & S., and Henry, of 
Chicago were both ruled out for rough playing. The Varsity 
tried twice for a place kick, but Sheldon and Kennedy failed to 
put it over each. time. Time was called with the ball in P. & S. 
territory. The score follows: 

CHICAGO. p. & s. 

Sheldon L. E. Dowdall, Donkle R. E- 

Wellington L. T. Lockwood R. T. 

Fell, Erwin L. G. McCormick, Hasset R. G. 

Speed -. C. Major C. 

Ahliswede, Cooke R. Gi' Carey L. G, 

Webb R. T. Alward L. R. 

Cassels K. E. Dean L. E. 

Kennedy Q. B. Turner. Q. B. 

Henry, Horton L. H. B. Comstock R. H. B. 

Hamill R. H. B. Hasset, Perry L. H. B. 

Slaker F. B. Flippin F. B. 

Touchdown — Slaker, Hamill. Goals from touchdowns — 
Kennedy 2. Umpire — Haddon. Referee — Hayner. Linesmen — 
Cochems and Robby. 

For P. & S., Flippen was by far the best all around gainer 
"though all played a fierce game. Capt Major mastered well all 
his kicks. Turner played and tackled low and hard. Donkle 
played a good game. The , plunges of Flippin into the 
line were fierce, and he seldom stopped until Kennedy grabbed 
him behind the line. The big Q. B. robbed Flippen and Hasset 
of many a good gain. 

Four thousand people saw the game. A noisy crowd of 
rooters accompanied the P. & S. team from the West side and 
gave good support from the west bleachers. Two thousand Var- 
sity people sat in the east stand and for the first time this season 
sounded the Chicago yell for the Maroons. 




JOHN LINCOLN PORTER, M. 1). 

Instructor in Oct liopedic Sursery, Collest'of Physiciar.s iS: Su 

jifoiis; Ass't. Attending Suj^t'on. Home lor CiiiiplfU Cliikl- 

rt'ii: t'liicf of crtliouedic Clinir. H:i l-tcd ^-t. Hospitiil : 

Attending Suriit'on. St. Luke's Dispcrisiirv ; Secff- 

t :ii-y of ( 'liicn'.'o Oct lio|icdic Society. 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 

UNIVERSITY OF ILLINOIS, 



^VOL. V. NOVEMBER 20th, 1899. NO. 7. 

THE EARLY DIAGNOSIS OF CHRONIC BONE AND 

JOINT DISEASES IN CHILDREN. 

John Lincoln Porter, M. D. 

Instructor in Orthopedic Surgery, College of Physicians «& Surgeons, Chicago 

The fact that over 50 per cent of the cases of rickets and 
joint disease that come to our orthopedic clinics give a liistory of 
having been treated, sometime during the disease, for various 
other disorders, is the only apology I shall offer for the subject I 
have chosen. 

When we consider that this class of cases show most excell- 
ent results and a very low mortality where treatment can be be- 
gun, early, it means that one-half of the cases that drift into our 
dispensaries and clinics, and in all grades of deformity and mis- 
ery, might have been saved a larger part of their burden of suff- 
ering and made more useful members of society, had the correct 
diagnosis been made and intelligent treatment begun at the on- 
. set of the trouble. 

As these errors in diagnosis are more apt to occur early in 
the disease, before deformity and the later classical symptoms 
have developed, we must bear in mind those indications which 
are first to appear and often pass unnoticed. 

I do not expect to offer you anything' new in this connection 
for the voluminous contributions to orthopedic literature of the 
past few years leaves little that is new to be said in the way of 
symptomatology. What I want is to emphasize the fact that ap- 
parently trivial ailments are often the definite early symptoms of 
serious bone lesions in children, and to insist upon the import- 



232 The Plexus. 

ance of the earliest possible recognition of them. For, while- 
many of these diseases are essentially chronic and all tend to 
spontaneous recovery, they all result in serious deformity, and it 
has been demonstrated beyond doubt that we can, by proper or- 
thopedic treatment both shorten the duration of the disease and 
prevent the resulting deformities. 

Undoubtedly, and also unfortunately, errors of diagnosis in 
children are as often due to lack of care in examination as to lack 
of ability to interpret and recognize what is found. 

The physician who looks at an ailing child without remov- 
ing its clothes, takes the temperature, examines its throat, listens 
to the mother's story and feels satisfied to make a diagnosis, is 
doing justice to neither his patient, himself nor his profession. 
If we would always remember that restlessness and diarrhoea are 
not always due to teething, that colicky pains may be caused by 
other disorders than indigestion, and that disinclination to play 
or move about on the part of the child usually means more than 
a weak back, we would make more thorough examinations of our 
little patients. 

The disorders most frequently quoted by the parents as hav- 
ing been previously diagnosed are (1) teething, (2) rheumatism, 
(3) colic and (4) weak back. 

Teething in the domain of children's diseases, like malaria 
in general medicine, certainly covers a multitude of sins. It is a 
convenient name to give to any obscure conditions in infants and 
when perchance the patient has cut all his teeth that handy term. 
rheumatism is at hand to bear the vicarious burden. 

As to rheumatism. The observations of our best clinicians 
bear out the statement that it is not a disease of childhood, and 
in infancy it is very rare, yet in spite of these facts it is a com- 
mon thing for cases of well defined joint disease to appear at our 
clinics after having been treated for rheumatism. 

As a fact the rheumatic diathesis in children manifests itself 
more frequently in the form of endocarditis, chorea, and tonsi- 
litis. 

I shall only refer here to the three diseases Ricket's, Pott's 
Disease and Hip Disease. They are the most frequent of all the 
joint diseases in children, they are the most frequently mistaken 
or overlooked in the earliest stages and the symptomatology of 
these three except for the differences due to location, is in gener- 
al the symptomatology of all of this class. 



Bone and Joint Diseases. 233 

Rickets — Without doubt the earliest indication of this dis- 
ease is a marked increase of phosphates in the urine, often they 
are so abundant that the freshly voided urine has a turbid almost, 
milky appearance, yet how frequently is the urine examined in 
diseases of infants and young children? Along with this is a 
restlessness at night and irritability by day with profuse sweat- 
ing about the head. Add to these a tenderness at the distal epi- 
physes of the long bones and about the chest that makes the 
child cry every time that it is handled and we have a clinical pic- 
ture that is always present before the "flattened skull"' and 
"beaded ribs" and other deformities described as diagnostic of 
the disease. Other signs sometimes, but not always present, are 
the enlarged and protruding abdomen, due to enlargement of liv- 
er and spleen, and bronchitis. 

Yet with all or some of these signs present, the mother tells 
us that before the legs become crooked, her child had a severe 
attack of "summer complaint", or that it cut its teeth "terribly 
hard". 

A glance at the pathology explains why some of these signs 
must appear early. The disease is primarily a constitutional 
dyscrasia in which there is a proliferative inflammation of the 
bony structure of the diaphyso-epiphyseal junctions accompanied 
by an excretion, instead of a deposit, of the bone-forming element. 
This accounts for the increased excretion of earthy phosphates, 
the restlessness and irritability, and tenderness at these points 
of inflammation. As a result of the tremendous excretory de- 
mands made upon the system we have the enlarged liver and 
spleen, the diarrhoea and profuse sweating. 

Spondylitis. Ridlon says "It must be remembered that 
spondylitis, easily demonstrable, is usually present some months 
before deformity of the spinal column is apparent." If that is a 
fact, and it cannot be doubted, then we certainly are not justified 
in waiting for the typical deformity before making a diagnosis. 
How is the disease "easily demonstrable" before the deformity 
appears? Chiefly by the muscular rigidity about the affected ver- 
tebrae. This sign may manifest itself in various ways according 
to the age of the patient and the location of the disease but to 
the eye of the trained observers it is always present, "it is the 
first to appear and the last to disappear and when, and only when, 
it is no longer present, can a cure be safely predicted. 

I do not mean to say that this is the only early symptom of 



234 Th Fie. V us. 

spondylitis, but I do mean that it is the most constant and the one 
upon which a diagnosis will often depend. In children who are 
old enough to walk, this rigidity of the muscles may be evident 
at a glance from the gait or posture, before any" examination is 
made. 

On account of it the child will carry himself very stiffly. If 
the disease is higli up in the spine in the cervical or upper dor- 
sal region, the head will be held rigidly and the patient will turn 
the whole body instead of turning the head. With the disease 
lower in the dorsal region the chest will be thrown out, the 
shoulders squared and the spine held very erect whether walk- 
ing or sitting. 

There is a disinclination to bend the spine in any direction 
and the knees are kept a little flexed to add springiness to the 
walk. All jars and sudden jolts are carefully guarded against. 
Instead of stooping to pick things up from the floor he will flex 
the hips and knees and squat down after them. The same condi- 
tion is seen in disease of the lumbar region except the squatting 
is more marked, there is pronounced lordosis and frequently the 
child has a peculiar sidling gait with one side of the body carried 
ahead of the other, that I have never seen in any other condition. 
Beside the gait and posture the spinal rigidity may be demon- 
strated by different methods of examination. To carry out these 
examinations place the patient prone upon a hard surface as a 
chair or table and begin by quietly rolling the legs. Then pick 
up the foot flex the knee and gently extend the thigh, one leg at 
a time. 

If no pain results the little one gradually submits to the 
handling. Then put one hand gently but firmly on the shoulder 
blades and pick up both feet at once and slowly lift the thighs 
and pelvis off the table. The normal spine permits of a consid- 
erable degree of extension in this way as well as in lateral bend- 
ing, but in case of bone involvement, before this normal amount 
of extension is reached, there will be felt the sudden arrest of 
motion, due to the muscular rigidity of some part of the spine, 
often the whole of the dorso-lumbar region, and the erector spinae 
muscles will be seen to stand out prominently with the effort to 
hold the spine rigid. 

If the cervical spine is suspected, the patient may be laid 
prone upon a table with the arms, head and neck projecting be- 
yond the edge of the table. In a normal spine the weight of the 



Bone (Old Joint DUeases. 285 

head will very soon tire out the posterior cervical and dorsal mus- 
cles and the head will begin to droop and soon dangle. If the 
spine be the seat of caries the head will be hekL rigidly and not- 
allowed to drop until the pain becomes intense. 

In infants similar tests for rigidity may be made by placing 
the patient prone across the se]3arated knees or arms of the 
mother. 

If one point of support is under the sternum and the other under 
the hips the normal spine will sag down in a long curve, while if it 
is diseased it will still be held rigid. 

Disease in the lumbar spine, by resulting contraction of the 
psoas muscles may produce a gait in walking that simulates hip 
disease but the differentiation is usually very quickly made by 
laying the patient upon his back and flexing the thigh until the 
psoas muscles are relaxed, when all movements in the hip flexion, 
ad-and abduction and rotation will be found to be normal. Frequent- 
ly the children that can walk will seek to support themselves 
and thus aid in maintaining the rigidity. They will stand with 
the hands on the thighs or on the seat of a chair, and in upper 
dorsal disease a favorite position is with the chin on the hand 
and elbow resting on some support. Along with this rigidity 
comes irritability and disinclination to move about or play and 
the patient becomes easily fatigued. 

Pain is usually an early symptom and is present in a large 
proportion of cases. It is not however complained of at the seat 
of disease, but is referred to the terminal distribution of the 
spinal nerves corresponding to the affected vertebrae. Children 
with dorsal Poti's disease are frequently treated for colic or 
stomach ache for some time before the correct diagnosis is made. 
Moore has said very truly "There is nothing else among diseases 
of childhood that will cause such persistent pain in theabdomen." 

Tenderness to pressure over the spine at the seat of the dis- 
ease has been taught for years by various textbooks and teachers 
as a diagnostic sign of spondylitis, but it is not there. The dis- 
ease is in the bodies of the vertebrae or on their anterior surfaces 
and direct pressure upon the spinous or transverse processes can- 
not reach the affected spots. 

Copeland of England places great confidence in the applica- 
tion of heat to the spine as the means of locating the site of dis- 
ease in very early cases. He passes a sponge wrung out of hot 
water down the spine and says that as the sponge passes over 



236 The Plexus. 

the affected vertebrae an acute pain will be produced, to subside 
as the heat is withdrawn. 

With these earlier symptoms is often a history of night cries. 
The child suddenly starts up from sleep with a sharp cry, usually 
falling off to sleep again immediately. The cries occur much 
more frequently in the early hours of sleep. 

It is necessary here to say a word about the differential di- 
agnosis between sjDondylitis and simple injury to the spine, and 
the typhoid and rachitic spines. An injured spine may produce 
the symptoms of Pott's disease but there is always the history of 
traumatism, the gradual insidious onset of spondylitis is lacking 
and under proper treatment recovery is rapid. Left untreated, 
injuries to the spine often become the exciting cause of true 
tubercular spondylitis, especially in patients with a tubercular 
predisposition. 

The typhoid spine is a sequel to typhoid or other intestinal 
fever, is painful to pressure and on bending. Some rigidity may 
be present but no pain in the area of nerve distribution. The on- 
set is rapid with temperature and recovery usually occurs in a 
few weeks. 

The rachitic spine may resemble the long dorsal curve of 
Pott's disease but there is no pain on motion, the rigidity, if it 
exists, is not so pronounced as in spondylitis and the spine can 
be moulded into normal shape. Beside the spinal affection there 
will always be found other characteristic signs of rickets in the 
enlargement of the radial or tibial epiphyses, costo- sternal bead- 
ing, bending of the long bones, flattened skull, etc. 

Hip disease. In children old enough to walk t\\Q first symp- 
tom is a limp. This is not due to pain, for often no pain will be 
complained of until long after the limp appears. It is due to the 
involuntary contraction of the psoas muscle preventing complete 
extension of the thigh as the body is carried forward. In infants 
the first indication of trouble may be restlessness, pain on motion 
or manipulation of the extremity, night cries, and a decided in- 
clination on the part of the patient to hold the limb still. Here, 
as in Pott's disease, the muscular rigidity to passive motion is 
the characteristic sign of joint involvement. Even in the very 
early development of the disease careful manipulation will show 
that all movements of the affected joint are less free than of its 
fellow, but motions that put the psoas muscles on the stretch 
usually elicit the rigidity most characteristically. A word as to 



Bone and Joint Diseases. 237 

methods of examination with younger children. At a time when 
the little patient is free from pain and fright lay him on his back 
with the clothing removed and gently extend both legs straight 
out upon the table. If one leg lies perfectly flat while the other 
knee is held up a little and is not allowed to go clear down, begin 
to be suspicious of the partially flexed leg. Then gently roll the 
well leg under your hand and notice that rotation and ab-and ad- 
duction are free and gently begin to flex the well leg upon the 
thigh and the thigh upon the pelvis. Notice whether the sus- 
pected leg gradually rises still further from the table as the well 
leg is carried into complete flexion. If the suspected joint is not 
affected it should be made to lie easily flat on the table with the 
other leg completely flexed upon the abdomen. If it is alfected 
even in a very slight degree, the thigh will remain flexed to a 
greater or less extent as the other leg is carried into complete 
flexion, and attempts to forcibly carry it down straight will pro- 
duce a marked lordosis of the lumbar spine and probably distinct 
pain. Frequently in the early part of the disease the patient 
will prefer to s^and on one foot, that is, the weight will be thrown 
on the well leg while the other is slightly flexed and rotated out- 
ward. Having tried the motions of the thigh with the patient on 
his back, turn him over in the prone position and try them again. 
Here, in the earlier part of the disease will be found the most 
marked rigidity to passive motion. With one hand placed firmly 
over the sacrum to hold the pelvis, pick up the well leg at the 
ankle and flex the knee, then extend the thigh upon the pelvis 
noting about how far it can be lifted from the table without re- 
sistance. Then try the suspected leg in the same manner. If 
the hip joint is deceased, as soon as an attempt is made to lift the 
thigh off the table the rigidity of the opposing muscles will be 
felt. Pain in the joint is not always an early symptom in hip 
disease. Sometimes the older patients will complain of a feeling 
of lameness about the joint after walking. The most frequent and 
earliest j)ain in this disease is complained of at the knee, generally 
about the inner surface of the joint. Pain in the hip joint itself 
usually does develop sometime during the course of the disease 
but generally not until deformity sufficient to call attention to 
the joint, has occurred, and occasionally we see cases that go 
through the entire course of the disease with no pain in the hip 
-except upon manipulations. 

Night cries, the same as described as occurring in spondy- 



233 Ta, Phixiis. 

litis are frequenil}^ heard in the early part of the disease, some- 
times not until abscess formation takes place, occasionally not at ■ 
all. Pain on passive motion as referred to above, is always an 
accompaniment of acute joint inflammation and is coincident with 
limitation of normal motion and muscular rigidity. Atrophy or- 
shrinkage of the muscles of the affected limb is always an early and 
marked symptom. Usually shortly after the limp is present and 
while the patient is still about on his feet and in infants as soon as 
pain on motihn i s noticed, a difference in tb e circumference of the two 
thighs and calves will be found and often the difference is marked 
in the first few weeks. Given then a case with slight limp and 
sensation of fatigue on walking, with or without pain in the joint 
or about the knee, but with limitation of some or all motions, 
with muscular spasm on passive motion and a difference in the 
circumferences of the limbs at given points, and a diagnosis, of 
early hip disease is inevitable. Hip disease in infants or before 
walking is begun is very rare, but the diagnosis must rest upon 
less active motion than in the other hip with pain on passive 
motion and muscular rigidity, without the redness, swelling and 
tenderness of acute rheumatic or septic arthritis. 

In closing let me repeat, that chronic bone and joint diseases 
offer a most excellent prognosis when treated early, that the- 
earlier manifestations of these lesions are often obscure, mis- 
leading or trivial in appearance; that delay means deformity and 
often a deformity that can not be corrected, and as a result, the 
patient must go through life handicapped, and bearing a physical 
and a mental burden for which he is in no way resi)onsible. 
Realizing this, then we should also realize the responsibility that 
demands of us as early diagnosis and as thorough treatment ot 
these cases as possible. 



SCHOLASTIC PANDEIVIONIUM. 

W. T. ECKLEY, M. D. 

Professor of Anatomy, Chicag-o Clinical School: Professor of Anatomy, N. W. 

Univei'sity Dental School; Professor of Anatomy, CoUeo-e of 

Physicians and Surgeons. 

The heading is a coinage of my own, so far as I know. Col- 
lectively it represents the unpunishable improprieties committed 
by medical students in their corporate, not in their individual 
capacity. Let us understand the full scope of the heading. If a 
student hurl an egg from a laboratory window at an organ 
grinder, as an admonition pure and simple, that a recitation is in 
progress, and the music must cease, this is a civil offense called 
assault and battery, and the burden of proof rests on the j^lain- 
tiff. If, however, the class of which said assailant forms an in- 
tegral part, becomes subsequently aware of the fact that the egg 
went shy of the musician's head, thereby perverting the use of 
the missle, and prostituting the dignity of the class marksman- 
ship, then the class body falls upon the student, who disregarded 
the memory of Wm. Tell, and proceeds to pass him up pro re 
nata, ac quantum sufficit. This is one of the elemental parts of 
pandemonium. 

Lest the proof reader spoil a good communication by challeng- 
ing the proijriety of the words in the heading, I wish to say in 
advance, in defence of the ritle, that there is a genuine euphone- 
ous classical stateliness in the combination, scholastic 'pandemon- 
ium. The true merit of the words is rhetorical, since by anti- 
thesis they bear the same transitional relation to the other words 
that the deportment of the medical student in public bears to his de- 
portment in school; in either case the transition is one from the 
sublime to the ridiculous. 

The reader must remember that the heading, scholastic pan- 
demonium, on analysis, is resolvable into the following diabolical 
Anglo-Saxon elements: catcalls, passups, pcdalic massage, 
cephalic showers, both hot and cold, inversely according to the 
weather, dead marches, rushes, holdups and assault and battery. 

The average medical student ha., a fine preliminary educa- 
tion. He has a receptive and active mind, and is withal, a good 



240 The FJexns. 

listener, and this by the way is the jewel setting of conversation; 
so let us o'ive him the benefit of the doubt, if any should arise, 
and say frankly, the average medical student is a good conversa- 
tionalist. Our student hears a lecture, reads up, makes a mental 
syllabus of his acquisition, and lays for his room mate, and after 
belaboring the classical terms involved in what he has heard and 
read, and made a cripple of the English language, and distracted 
his room mate, he triumphantly volunteers, not to do a thing to 
Prof. So and So on quinine for example. The receptive mind has 
received impressions; the active brain has converted these im- 
pressions into ideas, and our medic's mouth is a veritable valve- 
less excretory duct, through which manufactured brain concepts 
are delivered. 

Leaving entirely out of mind the medical student's wardrobe 
as irrelevant, he invariably has two suits of behavior; the one is 
for home use — the ordinary garb of deportment when he is in col- 
lege; the other is for state occasions. In this latter, the student 
habilitates himself on all occasions except as previously men- 
tioned. When not in school, and when so gowned, the student is 
invariably a gentleman, and a star in any kind of society in 
which he may happen to be sojourning. In fine, the medical 
student is a gentleman in the full sense of gentle, under all condi- 
tions, where he is taught by example and precept, to be a gen- 
tleman. Gentlemanly qualities are then, it will be understood, 
attributes for special and not for general use. The student has 
one very weak point. In school he is uproarious, undignified, 
and ungentlemanly, often carrying his mai-conception of sport to 
the danger line of the criminal. But for all this I contend he is 
clearly not to blame, for just so long as mothers lay special stress 
on company manners, and fail to enforce a uniform discipline at 
home; just so long as teachers in public schools elevate disci- 
pline and instrution for commencement occasion, and tolerate 
debasement of both in the routine working of the school, just so 
long will our medical college be full of students who are nursed 
on the belief that any deportment is good enough for home, and 
scholastic pandemonium will continue to hold high carnival. In 
this connection we must not lose sight of the fact that leaders 
are few, followers are many. Man is a gregarious animal. In a 
class of 100 students you will find about two leaders in rowdyism. 
The rowdy instinct is soon spotted by the class, and the leadeis 
in boisterous conduct, in spite of poor recitations and inferior 



Scholastic Pandemonium. 241 

mentality, are lionized openly and tacitly by class and faculty, 
and possibly this is so because of man's gregariousness. 

The leader, whom we may hereafter designate the bad boy 
of the class, runs to laryngeal nerves, cortical speech centers, 
and hypoglossal nuclei, rather than to frontal lobe qualities. 
Philosophically he is a social exotic, and belongs to one of two 
classes. 1. The underfed and overworked; or 1'. The overfed and 
underw^orked . 

The one condition is of lamentable as the other. In either 
case we are brought face to face with a melancholy example of 
that degenerate state of aesthetics in which the useless activity 
of unused brain power is the problem. The question of basic 
causation in scholastic pandemonium resolves itself to 1. An ir- 
risistable instinct on the part of the bad boy to call into useless 
activity unused brain power, with no ulterior use or benefit. 2. 
An irristible instinct on the part of the class to follow a poltroon. 

The word hazing is the polite term by which the improprie- 
ties now under fire are designated. These barbarities cover a 
range of torture, from passing a fellow student up, to maiming 
him for life. The incipincey of the practice antedates the oldest 
schools in the West, and is given an honorary j^lace in school af- 
fairs, somewhat akin to the honorary place held in criticism by 
poetic license . 

In substantiation of my theory that the bad boys who are the 
leaders in hazing, belong to a perverted class, striving to carry 
out the instinct of calling into useless activity unused organs, 
with no ulterior end or benefit, j^ermit me to remind you that in 
the Harvey Medical College, an evening medical schools, you will 
find none of this rowdyism. The students there, like the great 
majority of students in day colleges, belong to the class of man- 
kind who are enforced to call into useful activity, organs for 
ulterior benefit. The logical order of sane activities precludes 
from the evening school the very element that forms such a per- 
nicious factor in the day school. 

The treatment of the great evil attending scholastic pande- 
monium must be seriously considered sooner or later. The lead- 
ers are not lunatics, nor are they criminals, still they are dan- 
gerous elements in society and should be suppressed. As a rule 
they are cowardly like a bad boy in general and their nefarious 
practices can be suppressed. My candid opinion is, school au- 
thorities in the past have done all that can be done by legisla- 



242 The Plexus. 

tiou and expulsion to eradicate the great evil. Still hazing ex- 
ists today, virulent to limb and morals. The only way to eradi- 
cate the evil is to secure the substantial co-operation of the class 
as I think in this manner. Confer upon the football team the 
power of police duty about the school premises and remunerate 
the boys properly for their services, and scholastic pandemonium 
will have forever met its Waterloo. 

These remarks are not made for schools in Chicago alone, 
but for those institutions wherever the dangerous practice of 
hazing and kindred ungentlemanly conduct exists. 

5816 S. Park Ave., Chicago. 



THANKSGIVING. 

Now as ye joj'ous festive daj's 

Arrives on speedie wing, 
And alle yo. busie medic throng, 

Aside ye books do fling, 
Ye Plexus, with greeting, bids ye lose 

No time in idle talke, 
But bravelie maule ye turkie bone, 

With liardie knife and forke. 

iM. F. 01. 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OP PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 
UNIVERSITY OI' ILLINOIS. 

Editor, H. C. WADDLE, '03. Business Mgr. G. G. DOWDALL, '00 



Class Editors: 

H. B. HAMILTON, CO. CHAS. M NOBLE, 01. PAUL E. GRABOW, 02. 
GUYC. WAUFLE. '03. 



Faculty Department, Dr. W. A. Fusey. Athletic Editor, A. DONKLE, '01. 

Alumui, Clitiical Department, E. A. Gansel 



Publishers. ----- DOWDALL & WADDLE. 

Subscription $1.00 per Annum in advance. !im£;le copies, 15 cents. Issued Monthly 
Seud all i-L'mittances and conimunications as to subscriptions and advertising to G. Q 
DOWDALL, Rusiness Manager. S13 W. Harrison St. 

Entered at Cliicago Post Office as Second-Class Matter. 



Any subscriber desirins the Journal discontinued at the expiration of his subscription 
should so notify the Publishers; otherwise it will be assumed ^hai the subscription is to be 
continued and "the Journal sent accordingly. 

Contributions of matter suitable for publication are invited, and should be sent in not 
later than the 25th of the month previous to that of publication. The publishers willnot hold 
themselves responsible for tlie safe return of MSri. unless sufficient btamps are forwarded 

The editorial in last issue of Plexus concerning Dr. T. A. 
Davis' article should have stated that it was the first time that 
Josserand and Goiuard's article has appeared in English instead 
of the first time that the subject of Peritoneal Adhesions has been 
presented to the medical profession of the United States. 

Dr. Jno. L. Porter, who writes the leading article of this is- 
sue of the Plexus, has just taken up the work as instructor 
in Orthopedic Surgery in the college of Physicians & Surgeons, 
is a graduate of the Northwestern University Medical School, in 
the class of 1894. After graduating he spent two years as interne 
in St. Luke's Hospital and was clinical instructorin Orthopedic 
Surgery in Northwestern University Medical school from '9-4 
to '99. 

He is now assistant attending surgeon at the Home for 
•Crippled Children; chief of Orthopedic Clinic, Halsted St. Hospi- 



244 The Phxtis. 

tal; attending surgeon, St. Luke's Dispensary and Secretary of 
Chicago Orthopedic Society. 

Dr. A. T. Lemke writer of the article "The Rationale of Com- 
pression of the Lung for Tuberculosis"' is quite generally known 
by students of the P. & S. as he is an alumnus of the institution, 
being a member of the class of '95. Dr. Lemke is Dr. J. B. 
Murphy's assistant and is one of the busiest young practioners in 
the city of Chicago. 

On another page of this issue of the Plexus will be found a 
list of a choice collection of books donated to the library by Dr 
Quine. Among these will be found the Cyclopoedia of Medicine 
and several volumes on the practice of medicine. These are be- 
coming very useful to the students as the books are all up-to-date 
publications. Dr. Quine also donated seventy-five Journals of 
Medicine and several hundred copies of his well known little book 
on "Why I am not a Homoepath" and several copies on the sub- 
ject of typhoid fever. The pamphlets will be distributed to the 
members of the senior class. 

Dr. Harper has also donated seventy-five volumes of miscel- 
laneous works to the library. 

There is no department of a medical college which is of 
greater benefit to the general mass of students than a well filled 
library, and it is to be hoped that donations of choice books and 
magazines to our library will continue until it will be second to 
noQe in the United States. 

•X- 

* * 

It is with pleasure that we present in this issue of the 
Plexus the article "Scholastic Pandemonium," by Prof. W. T. 
Eckley, our genial instructor in anatomy, and we desire to em- 
phasize in our weak way the sentiments herein expressed. We 
most heartily believe that many of the rowdyish practices prev- 
alent in so many of the schools and colleges of today which are 
too numerous to mention, should be relegated to the past ages 
where they belong, and we believe that many of our schools and 
colleges are recognizing this fact and are doing away with these 
things, although there yet remain some which still continue their 
use. 

The most effective way of getting rid of these relics of 
barbarism is through class organization and class spirit. When 



Editorial. 245 

the class spirit and organization is such that the leader recog- 
nizes the fact that he has no following, then it will be that the 
institution afflicted will be rid of its pest. 

The class organization should be so strong that an outburst 
of rowdyism on the part of the individual would be promptly and 
effectually squelched. 

The leaders of these disturbances are not the leaders of the 
class in scholastic work, but as Dr. Eckley has so well said: 
"They run to laryngeal nerves, cortical speech centers and hy- 
poglossal nuclei rather than to frontal lobe qualities." 

We do not care to have our readers think that we do not be- 
lieve in the student, w^hoever he may be, having a good time; but 
we on the contrary, do most emphatically believe in his having a 
good time. "We do not however, believe in the destruction of 
property, the injury of participants, and too frequent the per- 
sonal insult that so frequently accompanies the practice so preva- 
lent in some institutions. 

* 

It is gratifying to note the spirit of progress pervading the 
field of athletics in P. & S. Too much cannot be said in com- 
mendation of the faculty, who have been the power behind the 
throne. Although athletics in P. & S. are still in the first 
stages of development, yet with the co-operation of the student 
body, it may be i^redicted that at no late date the College of 
Physicians and Surgeons w^ill stand second to none in athletics 
as it already does in medicine and surgery. 

Now that it has been demonstrated that one branch of 
athletics, foot ball, has come to stay, it can scarcely be expected 
that the whole student body should give it that support w^hich it 
needs and which it receives from the admirers and players of 
the game. There are hundreds of young men who could not 
play foot ball even though the dearest desire of their hearts 
next to the M. D. were to don the sweaters with the big P. S. 
There are others whose lines of recreation take different form, 
and again there are those who take little or no out- door recre- 
ation, or else are carelessly diffident to any thing pertaining to 
feats of strength, yet it is necessary to receive the support of these 
various classes of students to insure a system of athletics, which 
must be of benefit to the greatest number. This can be done 
only by branching out in such a manner that the greatest 
number are interested. The establishment of a modern gym- 



246 7 Ac Plexus. 

nasium, would be the first step in such a direction, and herein 
lies the rub, yet medical students are not prone to encounter 
difficulties passively, their activities need be directed in the 
right channels only and the right ends are attained. If athletics 
and gymnastics are essential any where, surely they are in a 
medical school. Would it be impolitic or impossible to add a 
dollar more to the yearl}^ tuition to bring such things to 
passy This would establish a beginning which would, in time, 
j)lace the A^arious athletic and club movements upon sound basis, 
then the financial and interest question would be well settled. A fee 
of this kind might entitle each student to membership in the 
athletic association and probably give him reduced rates to all 
games during the season, as well as the privileges of the 
gymnasium, bath-rooms, etc., etc. 



The editor of the Alkaloidal Clinic is a great worker. In pre- 
paring for this month's issue of the Clinic he "read twenty -four 
leading articles, five times as many letters as had room for, 
answered over four hundred queries and turned them in for in- 
sertion; three barrels of exchanges gone over in quest of items 
for the current literature, (chief among them the Plexus,', a 
dozen books, and j^amphlets without number, read and revised." 
Besides doing all this work the editor found time to give to the 
world in his leading editorial the Secret of the Success of the 
Clinic, which consists of blowing his own horn and that of those 
who give him a four jmge advertisemeyit. 

In former days the editorial pages of the monthly magazine 

were used for the benefit of the subscribers. Judging from the 

November number of the Alkaloidal Clinic they are now used for 

the benefit of the house that will give the magazine "a four page 

advertisement. " 

* * 
* 

One would think from reading the November number of the 
St. 'LiOUMi Bledical Brief, that Dr. Lawrence had gone fishing and left 
a political ward politician to run the lledical Brief duiing his ab- 
sence, at least it is charitable to Dr. Lawrence to think so. Cer- 
tainly no really high medical doctor, whose able pen has given 
the j^fediral Brief "the largest paid circulation of any medical 
journal published anywhere,"' would for one moment think of de- 
scending from the high plane of ethical medical journalism to the 



Editor ml. 247 

cess pools of pot house newspaper politics. We quote from t he 
Medical Brief: 

"Admiral Dewey is the right man in the right place — he has 
made that plain, but the chances are that he would make the 
poorest kind of a president. A military training does not favor 
the development of tact, a gift absolutely essential in a president. 
Grant was a military genius of the first water, but he made the 
poorest K'iiid of a jyyesident.'' 

•'The only people who are suffering are the capitalists, for 
interest rates have declined steadily during the past year, money 
being easy and plentiful." 

"Mr. Bryan is not a Democrat, but is now and always has 
been a Populist. The strange thing today is that there are so 
many old-fashioned Democrats who have renounced the princi- 
ples of their party, and abandoned the teachings of their fathers 
to follow the lead of this spurious Democrat into the quagmires 
of Populism." 

"The negro may have won his position as captain by doing 
his duty, but no military distinction on earth could make him the 
social equal of the white private. The negro is an inferior race, 
and will never make much progress until he recognizes his limi- 
itations." 

Whether the fact justify the criticisms of the learned doctor 
or not, does not warrant the editor of a great medical journal like 
the Brief in lowering himself from his high position to that of a 
country cross roads political editor. 

Dowie, and how he should be treated is an important qu es- 
tion. While individually it is of no consequence how he- is 
treated or what becomes of him, yet the poor deluded, ignorant 
followers of this man are worthy of pity and care. His every 
thought, movement, and desire is to so act as to bring upon him- 
self vituperation and abuse, with just enough violence thrown in 
so as to not hurt much but to make him a martyr in the eyes of 
his followers. He lives on excitement, feasts on abuse and can 
sustain himself only through martyrdom. The propei* way to 
treat Dowie is to let him alone, not go near him, pay no attention 
to his vulgar harangues, and he will very soon die of starv- 
ation. Neither should the police force of the city be prevented 
to aid in his nefarious schemes to make of himself a martyr. 
.If through his vile words and insulting language he stirs up a 



248 The Plexus. 

riot let him take the consequences, and in case it becomes 
necessary to make arrests to quell the disturbance, should one 
be started, the police should arrest Dowie, the instigator, and 
not the people who go to hear him and resent his insults. If 
this should be done and Dowie were locked up in a jjrison cell 
the riot would be at an end . In all criminal matters, it is the 
instigator of the wrong act that should be punished not the 
innocent sufferer who strike back in self defence. 




I'll itranlii'il In Ihirrisiiri. 



A. F. LEMKE, !M. I». 



THE RATIONALE OF COMRESSION OF THE LUNG 
FOR TUBERCULOSIS. 

By A. F. Lemke, M. D. 

It has frequently been pointed out by Clinicians, and occa- 
sionally by pathologists that the effect of compression upon a 
tuberculous lung is to favor the progress of the natural tendency 
to healing of tuberculous foci. The natural compression may re- 
sult from the effusion of pleuritis, whether serousor purlent,from 
pneumothorax and from deformities of the chest wall. The 
marked retraction of the chest wall that may follow the evacua- 
tion of pus in cases of empyema, complicating pulmonary tuber- 
culosis keeps the diseased lung permanently compressed and the 
tuberculous areas under such circumstances become thoroughly 
cicatrized. It is estimated that 83 per cent, of all cases of empy- 
ema that develop in adults are secondary to pulmonary tubercu- 
losis. Of 131 cases of uncomplicated empyema, operated upon by 
Koeing, Cabot and Runeberg (1) seven remained with fistulse 
and were incomplete cures, four died, and nine were lost sight of 
before the cure was complete- — all the others recovered from 
their tuberculosis as well as their empyema. 

When pulmonary tuberculosis is complicated by pleurisy with 
serous effusion it has frequently been observed, when the compres- 
sion was maintained for a considerable period of time, that, after 
the absorption of the fluid, the physical signs of the disease in 
the lung have been found much less marked or absent. In look- 
ing over the literature of pneumothorax, pleurisy with effusion, 
empyema and other conditions complicating pulmonary tubercu- 
losis, it is very interesting to note how frequently the older as 
well as the more modern writers have made mention of the good 
effect of compression upon the tuberculous lungs. Watson (2) 
cites a case of pneumothorax complicating pulmonary tubercu- 
losis in which there was a marked improvement of the pulmonary 
symptoms as a result of the compression and Osier (3) says 
t there are tuberculous cases in which the pneumothorax 



(1) Murphy, J. B.— Surgery of the Lung— Jour. Araer. Med. Ass'n. July 23 to Aug. 13, 1898. 
(3) Watson— Principles and Practice of Physic— 1857, Vol. II, p. 129. 
(3) Osier— Principles and Practice of Medicine— 3rd Edition, p. 883. 



-50 Com])rcssion of the Lung. 

if occurring- early, seems to arrest the progress of the tubercu- 
losis, and cites a case to the point. He also has observed cases in 
which an aj)ical tuberculosis has remained quiescent during a pe- 
riod of years owing to the development of pleurisy with effusion. 
Roseubach (4) states that pneumothorax developing in an 
individual in the early stages of a pulmonary tuberculosis, 
not infrequently is cured spontaneously, and may result 
in a complete cure of the lung tuberculosis. Hughes (5) 
as early as 1844 cited a case in which there was both clinical and 
pathologic evidence that compression of a tuberculosis lung aids 
greatly the natural tendency constantly at work in an effort to 
suppress the disease. A case is cited by an English i3hysician as 
early as the 16th century, in which a well-marked pulmonary tu- 
berculosis healed after the development of a pneumothorax re- 
sulting from a gun shot wound of the chest on the affected side. 
We may ask ourselves in this connection: How does com- 
pression of a tuberculous lung increase its capacity for circum- 
scribing and finally obliterating tuberculosis? Unless our hopes 
for the antitoxine treatment of tuberculosis are finally realized, 
we shall be obliged to attack this disease more or less indirectly 
by merely aiding the individual, and his lung tissue in particular, 
to resist the dissemination of the disease in the lung, and to ren- 
der inert the foci of disease which already exist in his lung. To 
quote Dr. Roempler: (6) 

"Upon the ability of the organism to resist depends finally the 
possibility^ of cure. To increase this power of resistance through 
gradual blunting of the susceptibility to irritation, through im- 
provement of the nutrition and quality of food, and finally 
through the avoidance of hurtful influences and through instruc- 
tion and training for future guidance, is the principal problem of 
the phthisio-therapeutist. 

If tuberculosis is active for a time, even though it be not ex- 
tensive, it usually follows that a mixed infection with various py- 
ogenic microorganisms results. It is this that represents the ele- 
ment of danger in that it increases the amount of secretion, and 
favors a dissemmation of the disease throughout the lung. It is 
usually not the tuberculosis per se that kills, but the mixed in- 
fection that goes hand in hand with it. 



(4) Rosenbacli— Notlinagel's Specielle Pathologie and Therapie— Bd XIV, Th. I. p. 234. 

(5) Hughes— London Medical Gazette— 1844. 

(6; Otis. E. A.— Hospitals and Sanitoria for Consumptives abroad. 



Tlte FJexus. 251 

The conditions that favor healing of tuberculosis in the lun,^ 
are quite identical with those that pertain to healino; of this dis- 
ease in other organs, except those differences tliat are tha result 
of the physical state of an organ such as tlie lang. A cavity in 
tlie lung, whether it be large or small, can scarcely be expected 
to heal readily on account, largely, of mechanical conditions. 
When we meet with such a condition in other organs we usually 
resort to some means by which the opposing walls of a cavity can 
be brought in apposition, or nearly so, and at the same time in- 
sure physiologic rest of the part. We do not expect a wound in 
the skin to heal, unless we bring about apposition of its lips, and 
this is one of the first principles of surgery. If we meet with an 
old osteo-myelitic cavity in a tibia, for instance, which is lined 
with granulution tissue, it is not expected that it fill up with scar 
tissue or bone unless we make some effort to approximate its 
walls or fill the defect with some substance which will make a 
mechanical support. If this absence of proper mechanical con- 
ditions be so detrimental to the healing of cavities in such a 
structure as bone, it is scarcely to be expected that a cavity in a 
lung in which there is continually an activity of the parts, will 
heal without them. It is a well-known fact that empyema cavi- 
ties which have been opened and drained fail to heal when me- 
chanical conditions are not such that the chest wall can be re- 
tracted, or the lung expanded, sufficiently to admit of the approx- 
imation of the two pleural surfaces, and surgeons never hesitate, 
under such conditions, to employ some form of thoracoplasty to 
bring about this desired effect. Lungs that have been extensive- 
ly involved in tuberculosis, or other diseases which destroy tissue, 
when repaired, show a contraction of the chest wall which is 
commensurate with the amount of tissue destroyed. 

The question is suggested: How shall we account for these 
experiences that we meet with clinically and pathologically, 
which go to show that when a tuberculous lung is compressed by 
pneumothorax and emjDyema, or a serous effusion, there is a 
marked hiiprovement of the tuberculosis? It has been suggested 
that the intoxication, or the pleural irritation, may, in some pe- 
culiar way, act upon the tuberculosis advantageously, much the 
same as it was once suspected that a malarial infection is intag- 
onistic to it. 

I do not wish to be understood that the collapse of a tubercu- 
lous cavity is the only thing to be desired, and it is quite evident 



252 Compression of the Lung. 

that com]3ression exerts a favorable influence on the disease in 
the lung in many respects. It obstructs mechanically the vari- 
ous avenues by which this infection is transmitted to other parts 
of the lung, the most important of these being the bronchi and 
the air-vesicles. Lymphatic circulation, which is next in impor- 
tance to the air circulation in propagating tuberculosis to other 
2:)arts, is also interfered with, and, according to some patholo- 
gists, it is the lymphatic circulation that plays the most impor- 
tant part in spreading this disease. 'When the function for organ 
is suspended its lymph circulation is interfered with. Spath '', 
in an article "Uber die Beziehungen der Lungencompression zur 
Lungentuberculose,"" cites an interesting case in this connection. 
In a case of miliary tuberculosis of the lungs, one lobe escaped in- 
fection entirely, and it had been compressed by pleuritic exudate. 
In the lungs, as in other tissues, toxic materials are carried into 
the general circulation through the medium, principally, of the 
lymphatic system and when this lymph circulation is interfered 
with, absorption is consequently proportionately diminished. If 
cavities exist in the lung that are not yet surrounded by connec- 
tive tissue walls they always contain more or less of the secretion 
from which some toxic absorption is continuously going on. The 
lung like a sponge, may be emptied of these secretions by exert- 
ing sufficient pressure upon it; at least these secretions are forced 
into the bronchi, where, as a result of the Irritation, they are 
readily expectorated. This is very often demonstrated on the 
operating-table during the injection of nitrogen. It is not un- 
common to have patients expectorate unusual quantities of these 
secretions during, or immediately after the operation. The ele- 
ment of physiologic rest of the organ involved probably plays 
some part in the process of rej^air; that it does in other t issues 
cannot be disputed. 

The rationale of pulmonary compression for tuberculosis is 
well put by Tidey ^ in an article in which he sets forth the val- 
ue of immobilizing, as much as possible, the thorax on the affect- 
ed side. "In health the respiratory capacity of the lung is com 
mensurate with the semi-circumference of the thorax. The dis- 
eased Inng may be regarded as decreased in bulk, so far as 
function is concerned, by the amount of lung tissue involved, and 
it follows that the best mechanical condition of respiration would 

7 Snath— Wurtemb Ospdbe. Bd Tviii No. 140. 

8 T idey-S. On the Mechnical Support (.f tl>e Lung in Phlliisis. British Mad ical Jour- 
nal, 1896, p. 721 



The Plexus. 253 

be secured, by reducing the thoracic cavity in proportion to the 
reduced bulk of lung. Natural processes of repair tend to secure 
these conditions, but only lead to complete cicatrization when the ~ 
disease is of a limited extent. We find then, clinically, a flatten- 
ing of the chest wall, dislocation of adjacent organs or hypertro- 
phy of the opposite lung. In so far as the inflammalory element 
in phthisis is concerned, rest and relaxation of the inflamed tiss- 
ues seem indicated and essential to the healing process. The 
English schools aim at developing the latent resources of the 
lung so as to compensate for the loss of the respiratory surface." 
Tidey also states that cases in which the attempt of developing 
the latent resources of the lung have been sucsessful, one finds an 
immense development of the base of the lung with an extensive 
cavitation toward the apex. The cavitation is a constant source 
of danger, while the hypertrophy does not necessarily secure 
proportionately increased aeration of blood, because the latter 
depends on range of movements as well as unaffected respiratory 
area, With permanently increased circumference of the lower 
thorax there must necessarily be decreased range of motion. 
Such cases suggest how much better it would have been if the 
compensatory hypertrophy had extended inward instead of out- 
ward, so as to have invaded and occupied the excavated region. 
Tidey emphasizes the fact that pleuritic effusions frequently lead 
to amelioration of the lung affection in phthisis. He sums 
up the advantages of mechanical support as follows: 1, in early 
stages — catarrahal stage — to give comparative rest and relaxa- 
tion to lung tissue; 2, in the stage of consolidation to secure the 
same results, thereby limiting the risk of extention and to pro- 
mote elimination of the disease products by improving the cir- 
culation in and about the diseased area and to facilitate expector- 
ation; 3, in the stage of cavitation, to promote the closure of cav- 
ities by directing healthy lung to encroach on diseased areas, in- 
stead of relying entirely on natural processes of cicatrization; 4, 
diminished tendency to hemorrhage by reduced tension on vessels 
and cicatricial tractions on walls; 5, the ultimate object is to ob- 
tain a smaller thoracic cavity filled with healthy lung instead of 
an enlarged thoracic cavily partly filled with diseased lung. 

It would appear from the results of experiments on dogs that 

when air is injected into the pleural cavity it is quite rapidly ab- 

.«orbed. This would tend to discourage the idea of attempting 

compression of the lung by means of intrapleural injections of 



25-4 Compression of the Lung. 

nitrogen. Unverrich demonstrated, by means of chemical analj'"- 
ses of the air injected into pleural cavities of dogs, that the dif- 
ferent gases are absorbed with varying degrees of rapidty — oxy- 
gen disappeared first, then carbon dioxid, and at last the nitrogen. 
When he irritated the pleura sufficiently to produce a serous exu- 
date, the absorption of the latter was also quite rapid, but slower 
than the absorption of the gas. This seems to have been the uni- 
versal experience of experimenters along this line. I have found 
no record of experiments made with pure nitrogen. In connection 
with the first case injected with nitrogen, that was reported by 
Dr. Murphy at Denver, it was demonstrated by repeated physical 
examinations and by radiography that the lung remained collap- 
sed something over two months. In the other cases, reported at 
that time, the absorption of the gas took place somewhat more 
rapidly, and it has been our experience since, that in the majori- 
ty of cases the absorption at the end of three and one-half to four 
weeks, had progressed sufficiently to make the breath-sounds 
audible. 

From the experiments of Unverrich we learn that the oxygen 
and the carbon dioxid are absorbed much more rapidly than the 
nitrogen, and, according to Fowler and Godlee, when a pneumo- 
thorax results from perforation of the pleura pulmonalis, the air 
in the pleural cavity has the same composition as that in the al- 
veoli: N, 79,5; CO., 4.38; O, 16. When the opening is closed, 
and it has been long jjresent, the oxygen disappears and the car- 
bonic acid and nitrogen relatively increase in quantity. From 
clinical observations in cases of natural as well as artificial pneu- 
mothorax it is evident that the rate of absorption depends, aside 
from the chemical composition of the gas. on the state of the ser- 
ous membrane and on the pressure which the gas exerts upon it. 
Hydrothorax may disappear rapidly or very slowly, depending 
on the condition of the pleura and the circulatory system. In sim- 
ple serous effusions a point is reached when the pressure on the 
pleura becomes so great that it would .seem absorption were prac- 
tically impossible and it is a well-known clinical fact that after 
the removal of a comparatively small amount of fluid, absorption 
may go on quite rapidly . This has been accounted for by sup- 
posing that the removal of the immense pressure permits of the 
ox>ening of the points of absorption. The gas may be absorbed 
in much the same way, and it is probable that the condition of 
the pleura, and degree of distention of the cavity, may govern, 
the rate of absorption. 



Compression of the Luiirj. 255 

The selection of the cases, for the purpose of excluding those 
in which the disease is too advanced, the determination of the 
existence of a pleural cavity, are probably the most difficult in 
the whole procedure, and are of the utmost importance. From 
our experience in the dead-house one would be led to believe that 
a goodly portion of all cases of tuberculosis is associated with 
more or less adhesive pleurisy, but our clinical experience has 
been that we were forced to aba>ndon the operation in but a small 
proportion of the cases selected. There is no infallible method 
for the determ ination of this point. The diminution or absence 
of respiratory excu rsion and retraction of the chest wall are high- 
ly suggestive, but are sometimes met with when no adhesions ex- 
ist. No doubt some of the cases that have been injected have 
had attacks of pleuris\^ which resulted in friable or band-like ad- 
hesions. It has occurred that during the progress of the gas in- 
jection the patient has complained of severe pain in a circum- 
scribed area definitely located and which sometimes suddenly 
disappeared. This woald indicate the possibility of severing some 
of the adhesive bands. 

In the selection of cases from the standpoint of the quantity 
and extent of tuberculous changes it is dilRcult to come to posi- 
tive conclusions. We have long since regretted that some pa- 
tients have been refused operation on account of the extent of 
the disease. I believe some of them might have been saved, if 
1 judge from the results in other advanced cases. I shall have 
occasion to refer to this again in dealing with the rejDorts of these 
specific cases. The earlier treatment is begun in pulmonary tu- 
berculosis, the better the prognosis. This is true with all meth- 
ods of treatment. Every physician realizes that a disease in the 
apex of the lung will yield more readily to treatment than a les- 
ion at the base, and that circumscribed foci are more readily aff- 
ected favorably than scattered areas, even though the actual 
quantity of lung tissue involved in the latter does not exceed 
that in the former. H. P. L.oomis% in a very able article, en- 
titled "Certain Points of Interest in Phthisis", speaks of var 
ious constitutional conditions that are to be considered in 
the prognosis of tuberculous patients. He states that pa- 
tients who have continuously more or less gastric symj^toms 
and who, therefore, are deprived of their greatest barrier to 
tuberculosis, do not usually progress favorably. Patients who- 



9 Loomis, H. P.— Medicine Record, 1898, pp. 731—738 



256 The Plexus. 

have veiy early in their disease a rapid pulse which is not de- 
pendent on an elevation of temperature are usually not favorable 
cases. Phthisis developing in old age is frequently latent for 
some time and very often chronic. The fibroid diathesis is a fav- 
orable condition. Hemoptysis should not affect our prognosis. 
The element of heredity does not materially, if at all, handicap a 
patient's chances for recovery. He also refers to the fact that 
the location of the disease in the lung is quite important in de- 
termining the chances of recovery, and refers to the effect of 
compression on tuberculosis in the lung. He says: "I have seen 
a number of these cases — tuberculosis at base of lung — and also 
advanced cases of ordinary apical tuberculosis, suddenly start to 
improve, and the patient, from being in a desperate condition, 
became comparatively well, this change following upon the fill- 
ing of the chest cavity on the affected side with effusion, the re- 
sult of tuberculous pleurisy."' Having in mind the favorable ef- 
fect of compression, Loomis experimented with cocoa butter., 
sterilized plaster of Paris, etc., but he either failed to produce 
sufficient exudate to compress the lung or infected the pleural 
cavities. 

I do not attempt to state specifically what constitutes a suit- 
able case for the compression treatmenr, and I have already stat- 
ed that the earlier the cases the better the prognosis, no matter 
what method of treatment is selected. Several of the cases that 
I shall report were very aggravated, and the question of the ap- 
plicability of the infection to these cases was extremely difficult 
to decide. 

For the operation the patients are put on the table, the skin 
in the neighborhood of the fifth and sixth interspaces, from the 
sternum to the post-axillary line, is carefully prepared, and the 
needle, which is an ordinary spear-pointed aspirating needle, is 
inserted in the fifth or sixth interspace, in about the anterior ax- 
illary line, or slightly further back, particularly when the left 
side is injected. It is important, after the needle is inserted, and 
before the tube is attached, to assure one's self that the point of 
the needle is in the pleural cavity, and this is done by instructing 
the patient to take a series of deep inspirations when, if the need- 
le be within the pleural cavity, a current of air can be heard to 
rush into it. If the needle has entered the lung, as it will when 
the two pleural surfaces are adherent, there is a slight current of 
air through the needle during forced expiration, and frequently a 



Compression of the Lung. 257 

little frothy blood will appear. After several deep insi^irations, 
if a little air has entered the pleural cavity, there will be a cur- 
rent during both phases of resjDiration. Sometimes, even though 
the mouth of the needle be within the pleural cavity, it is found 
that the current of gas meets with considerable resistance. This 
has frequently been noted in experiments on animals, and is due 
undoubtedly to the fact that the current of gas, unless much 
pressure be used, impinges upon such a small area of lung sur- 
face that it is not sufficient to overcome the cohesion that exists 
between the two layers of the x>leura, which has been estimated 
at 12.5 mm. of mercury. As soon as a small quantity of gas has 
entered, the pleural surfaces are slightly separated over a com- 
paratively small area, but sufficiently so that the inflowing gas 
under a slight pressure impinges on a greater surface of the lung 
and aids its natural elasticity to overcome the cohesive force 
which helps to maintain a condition of distention. As soon as 
the current is w^ell started, unless some adhesions are present 
from one to iive cubic inches of gas enters the pleural cavity with 
each inspirarion. The quantity of gas that can be injected de- 
pends on the presence or absence of adhesions, the amount of in- 
filtration in the lung tissue, the condition of the heart and the 
size of the pleural cavity. In an individual of average size, if no 
adhesions are present, eighty cubic inches of gas constitutes the 
minimum quantity that may be expected to collapse the lung. 
The maximum quantity that I have been able to inject is 170 cu- 
bic inches. The immediate effect of this artificial pneumothorax 
is to increase the number of respirations, to diminish the pulse- 
rate, and to dislocate the heart. Weil and Thoma,io in an exper- 
imental study of hydrothorax and pneumothorax, demonstrated 
that in closed pneumothorax and in hydrothorax, with movable 
fluid, the minute- volume of respiration is increased. There is an 
increase in the excretion of carbon dioxid, and the respirations 
are increased in frequency. If a considerable quantity of gas 
has been injected, there is occasionally a slight tendency to syn- 
cope, the pulse becomes slow and feeble and there is marked 
pallor. Sackur, in an experimental study of pneumothorax, 
demonstrated by careful measurements that after one lung is 
collapsed by a pneumothorax, the other respires as much air as 
did both together. The cough and expectoration are usally in- 
•creased immediately after the operation as the result of express 



10 Weil and Thoma— Virchow's Archiv. 1S79. 75, p. 483. 



258 The FJexns. 

ion of the secretions from the lung, and in cases where cavities 
have been compressad enormous quantities of purulent material 
are expectorated during and immediately after the operation. It 
is well to leave the needle in position for a few minutes after the 
current is turned off, so that a small quantity of gas can be with- 
drawn if the tendency to syncope is marked or the pain severe. 
The wound is sealed with collodion and, in order to avoid the es- 
cape of the gas into the subcutaneous cellular tissue, a tightly 
wound roller bandage is laid over the wound in the intercostal 
space and held in position with a long strip of adhesive plaster. 
This acts as an intercostal splint, and prevents the escape of the 
gas, which, without it, is sometimes considerable, extending into 
the cellular tissue of the neck so as to interfere more or less with 
respiration and deglutition. 

Of the possible accidents that may occur in connection with 
the operation may be mentioned: 1, gas embolism; 2, wounding 
of the intercostal vessels: 3, pulmonary hemorrhage from punc- 
ture of the lung tissue; and 4, wounding of the pericardium in 
the event of its being distended. 



CLINICAL LABORATORY DEPARTMENT. 
W. E. CoATES, M. D. 

Parasitic Origin of Tumors. 

Continued from October Plexus. 

Sanfelice in a later report dealt more exhaustively with the 
pathogenic blast omycetes and described the results obtained from 
further experiments with saccharomyces litogenes on guinea pigs. 

The nodules produced in the kidneys, which organs are most 
effected, have not an inflammatory character, since the nuclei of 
cells forming the nodules do not present the appearance of emi- 
grated changes. 

In the lungs the nodules are abundant and consist chiefly of 
proliferated interstitial tissue cells — the hyperplasia of the con- 
nective tissue resulting in an almost total disappearance of the 
alveoli. 

The liver nodules are composed of a connective tissue stroma 
containing numerous giant cells, and uninuclear cells resembling 
hepatic cells and Ijanphoid cells. New formed bile ducts were 
found in some instances in the newly formed fibrous tissue. Cal- 
careous masses, in some of which the original elements could still 
be recognized, were also present in the midst of the new formed 
tissue. 

A peculiar fact to be noted is that the longer the animal 
lived after inoculation, the smaller the number of blastomycetes 
present and the greater the tissue reaction. 

The deposit of lime salts (probably the phosi3hates) is 
ascribed to the reaction of the body cells which thus seek to 
protect themselves against the blastomyces. 

The saccharomyces litogenes results fatally for mice in 
about eight days after inoculation. 

Sanfelice remarks that it is not only important to study how a 
blastomyces normally behaves in the tissue, but also in what 
manner it degenerates, as otherwise it is easy to confound the 
stages of degeneration of the blastomyces with those occuring in 
the surrounding tissue. 

Sanfelice's carefully conducted experiments, along with 



260 The Plexus. 

results obtained by his co-workers ancl followers, warrant the 
writer's belief that the day has gone by when all elements 
described as carcinoma parasites may be considered as degener- 
ated tissue elements — some at least of the so-called degenerated 
tissue elements will be found to consist not of animal tissuei 
. elements but of vegetable tissue elements — these vegetable tissue 
elements being but stages in the life history of a fungus. 
Neither should we look for the same form of a particular fungus 
in every specimen of tumor of a certain type examined — the laws 
of alternation of generations of fungi, variation in spore for- 
mation, etc., must be carefully considered. Another point to be 
carefully considered is the probability that different types of 
tumors will be found to be due to different species of fungi. We 
cannot expect a common cause for every type and class of 
tumors any more than we could expect a given pathogenic 
bacillus for every bacterial disease — different species of bacteria 
give rise to different bacterial diseases — different species of 
blastomycetes and hypomycetes will, in the writer's opinion, be 
found responsible for different types of tumor growths. 

In reviewing the work of Sanfelice it is interesting to note 
that some of the blastomycetes discovered by him in tumors 
were identical with those found on the common lemon in Italy. 

R. Binaghi, a pupil of Sanfelice, maintains the parasitic 
theory of carcinoma and that blastomycetes are etiological 
factors in their development. He demonstrated their presence 
in forty out of sixty-three carcinomas and attributes the excep- 
tions to faulty fixation and to the fact that it is not always 
possible to find the parasites by examining a few sections only — 
another portion of the tumor may show them. 

Method of preparing and staining sections: 

Tissue is fixed in absolute alcohol or Mtiller's fluid being, 
when the latter is used, hardened in alcohol up to absolute. 
From absolute alcohol the tissue is cleared in xylol, then 
imbedded in paraffin. Sections are mounted with albumen, 
freed from paraffin with xylol, and then placed in absolute alco- 
hol, after which they are stained for five to fifteen minutes in 
Ehrlch's solution, washed in distilled water, treated from two to 
five minutes with Gram's solution, again washed in water, then 
dipped from two to three minutes in a 1% solution of watery 
safranin, washed in water, then dehydrated by passing through 
three dishes of absolute alcohol until the clouds of color cease to- 



Parasitic Origin of Tumors. 261 

be given off. Clearing in xylol and mounting in balsam com- 
pletes the process. 

The parasites in sections so treated api^ear violet or of a 
shining blue color, while the tissue is colored red — the parasites 
appear both free and enclosed in neoplastic cells, they are also 
found among the cells of round cell infiltration. 

"Chemic Reaction." — Binaghi, in answer to the contention 
that the so-called parasites may be the results of degeneration 
of tissue cells, claims that if sections containing the parasites 
are treated with sulphuric acid the tissue cells are gradually 
" dissolved, while the parasites remain and become highly 
refractive. 

The use of alkalies instead of acid yields even more striking 
results — the tissues entirely disappear and the parasites remain. 
These reactions are considered as proof of the cellulose character 
of the parasites. 

Binaghi's final conclusions are as follows: 

1. In cancer there occur constantly parasitic forms which 
diifer from the elements of the tissues and from other accidental 
elements. 

2. The parasites are, as far as their morphological proper- 
ties, specific reactions toward stains and with chemical agents, 
identical with blastomycetes. 

3. They are not found in other pathological conditions nor 
in normal tissues. 

4. Their relation to the cells of the neoplasm and their 
regular and definite distribution excludes the assumption that 
they are accidental, and the conclusion that they are the real 
cause of carcinoma is justified. 

Roncali in 1895 pablished a report of five sarcomata in all of 
which he found blastomycetes that resembled each other very 
much and were similar to those described by Sanfelice. In a 
previous report Roncali had reported the presence of similar 
blastomycetes in adeno-carcinoma of the ovary. 

These parasites take the specific stain of blastomycetes and 
resist the action of acids and alkalies, they are found within and 
without the cells, exceptionally within the nucleus; they multiply 
by budding and may in the earlier stages, i. e., when without 
membrane, possess an abundant chromatic protoplasm, or in the 
adult stage, i. e., with membrane, may have but little chromatic 



262 Th,j Flexus. 

protoplasm or a protoplasm that has entirely lost the power of 
staining with aniline dyes. 

Roncali also describes a blastomycis vitro-simile degenerans 
which acts similarly to saccharomyces litogenes described by 
Sanfelice. These names both call attention to the remarkable 
projDerties which some of these fungi possess, not only of under- 
going a rapid degeneration, but of displaying a peculiar calcar- 
eous dejDOsit over and around the degenerated cell membrane, 
which is probably due to calcium carbonate, since when these 
vitreous masses are treated with a 40^ solution of hydrochloric 
acid the degeneration forms all disappear, while treatment with 
40 j)Qv cent, sulphuric acid jaelds crystals closely resembling 
calcium suljjhate. As showing also their marked tendency 
toward degeneration, Roncali placed two pieces of tumor in a 
Petri capsule and kept it at, 37*^ C. for four days. In the juices 
the undegenerated forms were undoubtedly much more abundant 
than in the fresh specimens, .which would indicate their truly 
parasitic nature. 

Cultures were obtained in one case by preparing sixty tubes 
of distilled water containing a little sugar and acid; in each tube 
he placed small bits of tumor cut with a sterilized knife. These 
were kept at ol'^ C. for ten days, when surface growths were 
found upon forty-seven of them, which, when examined in the 
haaging-drop, were recognized as blastomycetes. 

Roncali in 1M97 again affirmed his belief in the etiological 
relation of blastomycetes to cancer for the following reasons: 

1. Moi-phologic proofs from the study of the histology of 
tumors. 

2. Successful isolation of the products (ferments) of malig- 
nant neoplasms in man. 

3. Production of malignant new grow^ths in animals by 
inoculation of isolated blastomycetes. 

The blastomycetes are morphologically identical with the 
so-called coccidia; they resist the action of concentrated acids 
and alkalies, are rarely found in other pathological, conditions 
(not at all — Binaghi); are found in tumors at the point of active 
growth, not in the center where degenerative changes are taking 
place. They are found either in the cell protoplasm, rarely in 
the nucleus, or between bundles of fibrous tissue; they react to 
specific stains and give the cellulose reaction with iodine. 

The lesions produced by blastomycetes in lower animals 



Pardsitic Origin of 7'umors. 263 

are variable, the higher animals (dog) are less susceptible than 
the lower (rabbit, guinea pig, rat, mouse, etc). 

Some blastomycetes produce lesions of a neoplastic and not 
of an inflammatory character. In dogs, the new growths pro- 
duced spread along the lymphatics to the various organs, and 
death results from cachexia. Some of the parasites inoculated 
into the mammary glands of sluts have jjroduced epithelial new 
growths. 

Kahane, who was one of the first to describe the presence of 
blastomycetes in malignant tumors, stated in June, 1896, that 
the blastomyces constantly found by him in malignant growths 
is nothing more than the common yeast, saccharomycetes cere- 
visias, and he then defines, tentatively, epithelioma, (on which 
his statistics have chiefly been based) as the expression of a 
peculiar symbiosis of epithelial cells, leucocytes and saccharo- 
mycetes. 

In an earlier paper, Kahane discussed the origin of carci- 
noma frotn the biologic standpoint, which he believes is the only 
one through which a correct understanding of the subject can be 
obtained. He found in living tumor particles of carcinoma and 
sarcoma the blastomycetes described by Busse and by Sanfelice, 
also w^iat he considered motile Kporozoa. The blood of persons 
suffering from malignant growths presents marked degenerative 
phenomena, and also "paracytic" elements probably identical 
with che motile sporozoa of the tumor. 

The interesting feature in Kahane's investigations lies in the 
fact that he apparently claims to recognize two forms of para- 
sitic life — the blastomycetes being vegetable, the sj^orozoa being 
animal in nature and forming a class, divided into four orders, of 
the protozoa, the lowest division of the animal kingdom. 

The presence of both vegetable and animal parasites in the 
same tumor, while possible, is hardlj^ probable. It is the belief 
of the writer that what Kahane describes as motile sporozoa are in 
reality zoospores of a vegetable fungus. 

In connection with the above suggestions an article by Dr. 
Behla, of Luckau, in a recent publication intimates in general 
terms that the people of Luckau, and especially of the suburban 
quarter called Kalau, owe the prevalence of cancer among them 
to the free consumption of fresh vegetables, and particularly of 
.salads. He states that a myxamoeba called PlasmodiopJiora 



264 The Plexus. 

brassicce, which frequently gives rise to an epithelial swelling of 
the roots of the cabbage, is very abundant in Luckau. 

There are many reasons for carefully considering this article 
from Dr. Behla, and a brief description of the PLasmodloplwra 
brassicae would not be out of place in the present writing. 

The Plasmodiophora brassicae is a species of Myxomii<ietes, or 
Myx'ogastres, an extraordinary group at one time considered as 
belonging to the fungi, but are now separated on account of im- 
portant structural differences, and by some are considered as- 
belonging to the animal rather than the vegetable kingdom. 
-'In the Myxomycetes, the spores on germination give origin to • 
one, two, or more naked cells, which possess the power of move- 
ment, due to the protrusion of pseudopodia, or the presence of a . 
cilium. These cells are known as swarm cells. The swarm cells 
possess a nucleus, multiply by bi-partition, and eventually 
coalesce to form a Plasmodium, also capable of movement." 
This represents the vegetative stage. No mycelium is developed 
during any period. The plasmodium eventually becomes sta- 
tionary, and resolves itself into a mass of minute round spores. 

The Plasmodio])hora brassicae attacks various kinds of cab- 
bage, turnips, radishes, etc. The root is the part most fre- 
quently attacked, resulting in the formation of various nodules, 
or wart-like outgrowths, or the entire root becomes swollen and 
clubbed, eventually rotting and emitting a very disagreeable' 
smell. 

A review of European investigation on the part played by 
blastomycetes and other fungi in the production of tumors would 
not be complete without offering the opposing views on the 
subject. 

Rabinovitsch in no case was able to find tumor-like masses- 
in the experimental animals such as Sanfelice describes. 

Busse reported a case of chronic pyaemia caused by a blasto- 
myces which produced similar lesions experimentally, with the- 
death of the animal. The changes produced were chiefly degen- 
erative; inflammatory changes, although present were slight. 

The presence of immense numbers of yeasts can produce- 
enlargements resembling tumors. While admitting the possi- 
bility, Busse cautions against haste in believing that all cell 
enclosures are parasites — if parasites, to what group do they 
belong y 

Buschke says that the existence of pathogenic yeast fungi is- 



Parasitic Orir/in of Tumors. 265 

established, but nothing indicates their connection with malig- 
nant tumors. 

Mafucci and Sirleo state that they were unable to obtain 
cultures of blastomycetes from malignant tumors that were not 
ulcerated. Their conclusions, however, are as follows: 

1. A lyriori they consider malignant tumors infectious in 
origin. 

2. The infective agent has not been positively determined, 
either through biologic or experimental proofs. 

3. The research after the infectious parasites should not be 
limited to one class of parasites. 

•4. Some species of blastomycetes possess pathogenic 
properties. 

5. The processes produced by them do not resemble new 
growths of the nature of sarcoma and carcinoma. 

6. Septicemia, suppurative and chronic inflammatory pro- 
cesses of the nature of granulomata are produced. 

7. The blastomycetes present in human carcinomata have so 
far, in animals predisposed to cancer, produced only ordinary 
inflammatory processes. (They do not accept Sanfelice's experi- 
ment on dogs as proof of the power of blastomycetes to produce 
epithelial new growths). 

8. The presence of blastomycetes in carcinoma and sarcoma 
in man cannot always be demonstrated histologically or by culture. 

9. Blastemycetes are found especially in ulcerating malig- 
nant tumors in man. 

10. The distribution of blastomycetes in tumors suggests 
that an infection has been superadded. 

11. The possibility of blastomycetes causing malignant 
tumors is not excluded, but they do not believe any experimental 
proofs exist. 

12. They do not deny that protozoa (psorozoa) can produce 
new growths; this is proved by the papilloma caused by the 
cocc. 'um, but there is no experimental proof that they can cause 
carcino z a and sarcoma in animals susceptible to these diseases. 

(To be coutinued). 

Note:— The present article concludes a review of • j .„ . ,, 

tigatlons on the presence of vegetable fungi in tumors. Future articles will review the 
work of English and American investigators. The subject of blastomycocis and blastomy- 
cetic dermatitis-infectious processes due to pathogenic blastomycetes and closely allied 
to epithelimota— will be received in a separate article. A complete bibliography of the 
literature from which further information may be obtained, will accompany the final 
paper. 



263 Tlte FUxus. 



CITY SONG. 

Tliis is a song of the city 

Where the faces of men are as brass, 
And their hearts are as cold as the icy seas 

And as dark as the dank morass. 

Aye, and the soul is for barter, 

And the tenderest flesh is for sale, 

Where the ring of the dollar is laughter's ring 
And the virtuous maid is stale. 

Sad. it is sad, it is more than sad, 

Yet the grime and the filth cover all, 

And the clang of the traffiking carts is loud 
It is louder than love's low call. 

Fumes, and the soot, and the clamor, 

They have entered the brain and the heart, 

Till the fever of gain has confuted the soul 
And it seeks for its peace in the mart. 

Baubles are better than sun-light, 

And daubs, they call pictuies, than trees. 
And the paint on the face is a pass to love, 

To a love that is hawked for fees. 

Mad, they are mad, they are more than mad 
When they dwell in the city with Cain 

And the clang of the traificking cart is loud 
It is louder than all but gain. 

Loud, it is loud, it is very loud 

But it is not as loud as the pain. 

Not as loud as the terrible silence of God 
That IS brooding over their sla'n; 

Over the slain of the city 

With a judgment sure as the night. 
That is branding the murderer's haggard brow 

With the frenzy-lines of fright. 

Sad, it is sad. it is more than sad, 

Yet the grime and the filth cover all. 

And the clang of the trafficking carts is loud 
It is louder than love's low call. 

George Richards Parr. 



^lipiGol Oepartrpeph, 



COLLEGE OF PHYSICIANS AND SURGEONS. 
E. A. Gansejl. 

Prof. Babcock spares no pains in making liis work interest- 
ing and his eiforts are appreciated fully by all the members of 
his class. In order to illustrate the clinical points in his lectures 
he always has one or more patients present, suffering with the 
disease or symptoms which he is presenting for study. In order 
to have cases which will illustrate the various symptoms and 
stages of the disease presented, Prof. Babcock, at the expense 
of considerable time and exertion, goes out to the hospital at 
Dunning and there personally examines and selects such cases as 
it is impossible to find among dispensary patients. After the 
clinic and oftentimes later during the week the students are 
given the opportunity to carefully examine these patients and 
thus see, feel and hear for themselves the importat physical 
symptoms spoken of in the previous lecture. 

On Saturday, Nov. 11th Prof. Byford in place of giving his 
regular lecture presented to the class a very interesting case for 
operation. The patient was a lady who for a number of years 
has been suffHring from pelvic disturbance. She had been 
treated previously in various ways but found no relief. Prof. 
Byford through vaginal operation found that the trouble was 
due to a large dermoid cyst located in Douglas's cul cle sac. This 
was entirely removed and upon examination of its contents 
showed among other things a firmly matter tuft of hair about as 
large as a good sized hen's egg. 

REMOVAL OF GASSERIAN GANGLION. 

Prof. Murphy, at his clinic on Oct. 31st, presented the fol- 
lowing interesting case: 

Family History: — Father died at ninety years of age of gan- 
grene of the foot. Mother died at age of eighty- six of maras- 
mus. One sister died of paralysis, another after an ovaritomy 
operation. 

Personal History:— A lady fifty-one years of age, occupation 
housewife; has had the ordinary diseases of child hood. Five 



268 The .Plexus. 

years ago she had. a severe attack of influenza and pneumonia. 
Menstruation has been regular but always painful until the flow 
started. Menstruation ceased when she was thirty-seven years 
of age. Has been married thirty years, has no children and has 
had no miscarriages. 

Present Complaint: — Four years ago last spring was suddenly 
attacked with agonizing pain near right alanasi which shot 
uj^wards over right eye and right temple and downward over the 
lip. Pain was almost constant for some three weeks. Since 
that time patient has had repeated attacks at intervals of from 
one 1o three days. She was at one time free from pain for three 
months. One year ago last July she fell and fractured her skull 
on left side above eye and had a severe contusion of left side of 
neck. Did not have any neuralgic attacks while laid up with 
this injury. During past year has not been free from pain for a 
single day. Eating, drinking, moving of lips or right eyelid 
was often sufficient to start a paroxysm of pain. Attacks are 
gradually becoming more frequent. 

Operation: — Head completely shaved then covered with anti- 
septic dressing for forty- eight hours. Horseshoe incision 
through skin and periosteum begiiming just behind the external 
angular process of the frontal bone and ending just in front of 
the ear. With a grooved chisel an opening was made through 
the bone large enough to admit the bone forceps with which the 
same line of incision was made through the bone. Osteoplastic 
flap was raised with chisel and periosteal elevator. Temporo- 
splenoidal lobe was carefully lifted up with the fingers thus 
exposing the middle fossa and later the second and third divis- 
ions of the fifth nerve. With blunt hooks these nerves were 
raised up and severed. Next the gasserion ganglion was carefully 
isolated from the dura and bone, grasped with forceps and 
forcibly removed. 

The hemorrhage was not severe and was controlled by a 
small gauze packing. The flap was turned back into its proper 
position and the skin incision closed with interrupted silk-worm 
gut sutures. 

Time of operation fifty-five minutes. 

Course: — Gauze packing removed in forty-eight hours, hemor- 
rhage having entirely ceased. Patient after fourteen days has 
suffered from no bad effects of any kind from the operation and 
has had no further neuralgic pains. 



LIBRARY NOTES. 
Grace W. Bryant, Librarian. 

A list of the books donated to the library by Dr. Quine 
which was noted in the October Plexus, may be found at the end 
of these notes. 

During the last month the growth of the library has been 
marked by the following important gifts: Dr. J. E. Harper, 77 
volumes, and Fox's "Atlas of Skin Diseases;"' Morrow's Atlas of 
"Skin and Venereal Diseases;*' Dr. J. M. G. Carter, about 600 
valuable journals, among them several volumes of the "Berliner 
Klinische Wochenschrift," a journal very much needed in the 
library; Dr. C. A. Wood, Yaggy's "Anatomical Chart" and about 
150 journals including volumes of "Le Progres Medical." "La 
Presse Medicale,"' Die Therapie der Gegenwast," "Wiener 
Klinische Rundschau" and "Die Medicine der Gegenwast;" Dr. 
A. B. Hale, 14 volumes; Michigan State Board of Health, 30 
bound volumes and about 50 unbound reports on sanitary ques- 
tions; Chicago Homeopathic Medical College, five volumes. 

By exchange with the R. I Medical Soc. we have completed 
many more files of our journals and have added several volumes 
of the British Med. Jour, and London Lancet. Owing to lack of 
space and such a long list of new books we must necessarily de- 
fer a part of the list of the names of the above mentioned gifts 
until next month. 

Dr. Milnamow has been the one to inaugurate a movement 
we hope may prove wide- spreading among those interested in 
the library, viz. : He has given !^5.00 for a year's subscription 
to the "Journal of Experimental Medicine" for the library. The 
librarian will gladly receive any other subscriptions for jou-rnals 
needed, and will attend to the sending for them. 

The following articles from members of the Faculty have 
been noted in the journals during the last month: 

Dr. W. T. Eckley, "Reflections on the Anatomy of Inguinal 
and Femoral Hernia," Chic. Clinic, Oct. 1899, p. 397-400. 

Dr. L. H. Mettler, "The Poetry of Science," Werner's Magazine, 
Oct. 1899, p. 95, 

Dr. G. F. Lydston, "The Surgical Commission Man and 



270 The FlexrCs. 

Surgical Canvassing," Phil. Med. Jour., Nov. 4, 1899, p. 837; 
"Adenoma of the urethra," Joxcr. A. M. A., Nov. 11, 1899, p. 1211. 
Dr. P. R. Sherwood, "Surgical Importance of the Cervical 
Lymphatics," Chic. Clinic, Oct. 1899, p. 884-30. 



NEW BOOKS, 



DR. QUINE'S gift OF BOOKS. 

Aitken, Wm. — Science and Practice of Medicine, 2 V. Ed. 
5, 1883. 

Charteris, M. — Handbook of Practice of Medicine, 1878. 

Fagge, C. H. — Principles of Practice of Medicine, 2 V. 1886. 

Hughes, D. E.— Practice of Medicine, Ed. 6, 1899. 

Lockwood, G. R. — Practice of Medicine, 1896. 

Loomis, A. D. — Practical Medicine, Ed. 11, 1895. 

Page, R. C. M.— Practice of Medicine, 1892. 

Roberts, P. L. — Theory and Practice of Medicine, 1884. 

Stevens, A. A. — Practice of Medicine, Ed. 4, 1896. 

Smith. N. S. — Principles and Practice of Medicine, 1884. 

Taylor, P. — Practice of Medicine, 1890. 

Trousseau, A.— Clinical Medicine, 3 V. Ed. 3, 1867. 

Williams, C. J. B. — Principles of Medicine, 1866. 

Ziemssen, H. Von — Ed. Cyclopaedia of Practice of Medicine, 
20 V., 1874. 

::oubleday, E. T. & Nagel, J. D.— Practice of Medicine, 1892, 
(Quiz compend.) 

Allbutt, J. C— Visceral Neuroses, 1884. 

Burt, W. H. — Clinical Companion to Physiological Materia 
Medica, 1883. 

Cameron, C. A. — Manual of Hygiene, 1874. 

Clevenger, S. V. — Comparative Physiology and Psychology, 
1885. 

Clouston, T. S. — Neuroses of Development, 1891. 

Connecticut Health, B'd. of — Annual Report for 1882. 

Day, W, H. — Headaches, their Nature, Causes and Treat- 
ment, 1883. 

Dujardin. Beaumetz. — Diseases of Stomach and Intestines, 
1886. 

Erichsen, J. E. — Concussion of the Spine, 1886. 

Foster, M. — Textbook of Physiology, 1895. 



Ak-in Bon/.s. 271 

Graclle, H.— Bacteria and the Germ Theory of Disease, 1H83. 

Hare, H. A. — ^Practical Therapeutics, Ed 5, 1895. 

Harley, G. — Diseases of the Liver, 1MS3. 

Hektoen, L — Technique of Post-mortem Examinations, 1H94. 

Hh-st, B. C— Tex 1 book of Obstetrics, 1^98. 

Holmes, T., E 1.— System of Surgery, 8 V. 18H1. 

Jakob, C. — Clinical Diagnosis and Pathology and Treatment 

of in'erual Eisf ases, IKJS. 
King, A. F. A .—Manual of Obstetrics, Ed. 7, 1898. 
Kyle, D. B. -Diseases of th-^ Nose and Throat, 1899. 
Loomis, A. L. — Physical Diagnosis, Ed. 3, 1879. 
Maclagan. T. — Germ Theory of Disease, 1876. 
Marshall, A. M. & Hurst, C. H.— Practical Zoology, Ed. :>, 

1899. 
Martin, F H.- -Fibroid Tumors of the Uterus, 1H97. 
McClellan, G. — Regional Anatomy, 1891. 

McNutt. W. F.— Diseases of the Kidneys and Bladder, ls<)3. 
Meigs, A. V. — Origin of Disease, 1897. 
Ohio, Health B'd. of —Annual Report for 1893. 
Osier, Wm — Diagnosis of Abdominal Tumors, 1S95. 
Piersol, G. A.— Normal Histology, Ed. 3, 1895. 
Quain — Anatomy, V. 1, pt. 1, Embryology, 1898. 
V. 1, pt. 2, Histology. 

" " V. 3, pt. 1, Spinal Cord and Brain. 

V. 3, pt. 2, The Nerves. 
Remsen, Ira — Organic Chemistry, 1S99. 
Stewart, G. N.— Manual of Physiology, Ed. 3, 1895. 
Ruckley, H. R. — Diseases of Liver, Biliary Passages and 

Portal Vein, 1883. 
Spitzka, E. C— Insanity, 1884. 
Tyson, J. — Physical Diagnosis, 1891. 

Venablas, R. — Urinary Analysis and Diagnosis, Ed. 2, 1843. 
Waring. H. J. — Diseases of the Gallbladder, 1897. 
Warren, J. C. —Surgical Pathology and Therapeutics, 1897. 
White, W. H. & Wilcox. R. W.— Materia Medica^ Ed. 4, 189,s. 

OTHER GIFTS. 

Rose, W. & Carless, A.— Manual of Surgery, 1h98. Wood 
Co., donor. 



The Plexus. 

WhartoD, H. R. — Minor Surgery and Bandaging, Ed. o, l-^^^B. 

Er. W. M. Haisl a, dcrcr. 
Zuckerkandl, O. — Atlas and Epitome of Operative Surgery, 

1898. 



ALUMNI NOTES. 



"99. LoraL. Basiy, GJ] Blue Island Ave., Chicago. 

"99. Helen L. Hisom, Los Angeles, Cal. 

■99. P. G. Sanderson, 1^01 E. Warren Ave., D troit, Mich. 

■99. Hannah L.. Hukell, Mary Thompson Hospital, Chicago. 

'99. H. C. Heald, Millard, Neb. 

'99. John P. Grimes, A'exian Bros". Hospital, Chicago. 

'99. LBon Pen^oll, S' ElizibiVa's H )iplt il, Cilci^-j. 

'99. Ira Pran'v, Mich 13I R^ase Hospital. Chicago. 

'99. W. A. Evans, 10 5 State St., Chicago 

■99. John M. Edwards, Lexington Ave., New York City 

•99. E. A. Chloupek, 'I'isch Mills, Wis. 

'99. Jas. Moreau Brown, 31 Wa.shington St., Chica ::o. 

'93. C. A. Batler, D3II Ripids, S. D. 

'99. W. H." Chambers, 30 5th Ave., McKeesport, Pa. 

'99. T. R. Hilliard, Eau Cla re, Pa. 

'99. P. W. Myers, Ramos, San Luis Potnsi, Mexico. 

'9c). E. R. Whitmore, Cook County Hospital, Chicago. 

'99. Eugene A. Sullivan, Amboy, 111. 

'99. O. E. McWilliam.s, Anderson, Ind. 

'99. J. E. Swan^on, Woo IhuU, Dl. 

'99. J. G. Potter, New L )ndon. Wis. 

'99. P. D. Moore, 411 Oakley Boulevard, Chicago. 

'99. D. E. Lucas, 1279 W Midi^oa St., Chicigo. 

'99. E. W. Timm. North Ave. and Holton St., Mdwaukee. 

Wis. 

'99. P. P. Ramsey, Rapid City, Michigan. 

'99. Geo. S. Brow^ning, Alexian Bros'. Hospital, Chicago. 

'99, P. S Burnes, Oskaloosa, Iowa. 

'99. Thurston Smith, Blooraington, Ind. 

'99. C. E. Sisson, Men !ota, Wi-s. 

■99. Theodore Tieken, Cook County. Hospital, Chicago. 

'99. Val Demar Pleth, T.")!) W. North Ave., Chicago. 

'99. Sally A. Yingst, oiT)" Indiana Ave. Chicago. 



Alum 111, NdtcF-, 27.') 

'1)11. W. K. Yeakel—Prof. of Patholcgj, Omaha Medical 

Colleare, Omaha, Neb. 

"1)^). Jas. W. Wherry, Ass't. Ph sician, Iowa State Hospi- 
tal, Clarinda, Iowa. 

'Ul>. W. F. Reich, M. D. 4::i\ IGth. Ave . Milwaukee, Wis. 

'<)ll. A. F. Bechtold, Forest City, 111. 

'W. Frank W. Meyers, Dubuqne, Iowa, 

"Uli. H F. Andrews, Gunnison, Utah. 

'^)i>. C. A. Albrecht, Norwegian Lutheran H )spltal, Chicago 

"99. J. W. Backus, Norwegian Lutheran Hospital, Chicago. 

"99. S. M. Strohecker, V)V.)2 Winston Ave., Chicago. 

'9<'. H. H. Bay, Lake Side Hospital. Chicago. 

"99 J. C. Betz, West Side Hospital, Chicago. 

■9;i. T. J. Burke, DeWltt, lov^a. 

"99. W. B. Campbell, Milwaukee, Wis. 

"99. H. C. Carroll, r)47U Kimbark- Ave., Chicago. 

•99. C. M. Coen, Mendota, 111. 

"99. C. H. Czarra, 551 Jackson Blvd., Chicago. 

"99. B. Pantus, Cook County Hospital, Chicago. 

"99. Marie A. Fellows, i^si? Dearborn St., Chicago, 

"99. F. L. Freas, Sterling, 111. 

"99. II. Gathman, Americrn Soap Journal, New York City. 

"99. J. W, Garth, Clarion, Iowa. 

"99. B. C. Grabowicz, r)76 Milwaukee Ave., Chicago. 

"99. J. L. Hammond, Masonic Temple, Chicago. 

'99. F. G. Harris, Si;] W. Harrison St., Chicago. 

'99. A. E. Herzog, Ottawa, 111. 

"99, C. C. Hummill, Grundy Center, Iowa. 

"99. Mary Gill Hunter, North Mineralville. Ohio. 

'99. A. Jacobson, 477 Ogden Ave., Chicago. 

"99. A. E. Kay. 1707 Harrison St., Chicago. 

'99. L. H. Kelley, Valparaiso, Ind. 

"99. M. J. Klein, 1002 Wellington, Ave., Chicago 

'99. W. E. Klokke, 235 S. Lincoln St., Chicago. 

'99 F. B. Knndson, 389 W. Erie St., Chicago. 

'99. E' O. Koeneman, Whiitier, Iowa. 

'99. A. G. Kreuger, Carmine, Texas. 

'99. W. E. Long. Mason City, Iowa. 

'99. R. D. Long, 100 State St., Chicago. 

'99. O. E. Macy, Pleasonton, Iowa. 

"99. E. H. Madajesky, Appleton, Wis. 



■99. F. F. Mark-ey, l^lU, i8th. St.. Milwaulvee. Wis. 

■99. Alberta V. McClung, 6106 Greenwood Ave , Chicag-o- 

■99. C. E. McCormick, U37 W. Hirrison St, Chicago. 

'99. R. G. McCarthy, Tacoraa, Wash. 

■99. J. E. Metcal'', West Side Hospital, Chica-o. 

'99. W. C. Olson, LaCrossG, Wis. 

'99. J. A. Peters, Iowa City, Iow;i. 

'99. B. M. Plait, N) Institute Place, Chicago.. 

■99. E. J. Ran. Marcus, Iowa. 

'99. M. A. Reasoner, Morrison ville, III. 

'99. F. A. Richards, Whitewood, S. D, 

'99. H. R. Russell, Stewartville, Minn. 

■;)9. A. J. Schoenberg, 422 Irving Park Blvd., Chicago. 

■99. G. F. Schieb, Edinburg, 111^ 

'99. C. H. Slightam, Maaison, Wis, 

"99. F. B. Steele, Delhi, Utah. 

'99. A. W. Stillians, Cook County H )spital. 

"99, J. H. Turner, West Side Hospital, Chicag'o. 

•99. E M. Wanecel.', 120 Blue Island Ave., Chicago. 

'99. E. A. Weichbrodt, 100 Stale St., Chicago. 

■99. J. W. Wenzel, Lake Side Hospiial, Chicago. 

'99. j^i-roy A Wilson, Michigan City, Ind. 

'99 Glenn Wood, 903 W. Monroe St., Chicag... 

'99. A. R. Lemke, Cook County Hospital. 

*SC. Dr. E. A Van Tuyl of Riverside, 111., died in Denver, 
Colo., Oct. 26. He left a wife and three children. 



P. & S. MEDICb) ROLL UP BIG SCORES. 

P. & S. eleven defeated North Western Dental College by a 
sc;>re of 39 to 0. This game was one of the prettiest and fastest 
game P. &. S. has played this year. All played with snap and 
the punting of Bothne was excellent, he jjunted long distances 
and high, giving the ends time to get down the field and nail the 
man, with little gain. 

The game with St. Charles resulted in a tie, neither team 
scoring. If P. & vS. had had all tlie regulars in the game, no doubt 
they would have won. Neither Capt. Majors, McCormick nor 



Athletic Notes. 275 

Flippeii were in the game, but even then P. &. S. had them going 
most of the time. 

Tlie game between Chicago Dental College and P. & S. re- 
sulted in a final score of -^ to 0, it being an easy victory for P 
& S. In this game P. & S. played low and hard, but were 
slow in getting off at the snap of the ball. Cory played an ex- 
ceptionally strong game, repeatedly breaking through the line 
and downing the opponent back of the line for a loss. Dean 
played his usual strong game at end. 

The game at Lake Forest resulted in an easy victory for P. 
& S., the score being 38 to 0. The game was played in a driving 
rain storm. During the first half the P. & S. team had the wind 
and rain with them, and Lake Forest did not gain the necessary 
five yards a single time, nor did the P. &. S. lose it on downs. 
The second half was cut short on account of the storm, but in the 
eight minutes of play P. & S. made two touchdowns. Line up: 

p. & S. I.AKE FOREST. 

Dowdall R. E. Hassock L. E. 

McCormick R. T, Parshal, Cody L. T. 

Parry R. G. Styles, Beitner L. G. 

Cory C. Swift C. 

Hassett ; ... L. G. Stork, Francis R. G. 

Lockwood L. T. Libbey, Beach R. T. 

Dean L. E. Ross R. E. 

Turner, Donkle Q. B. Vincent Q. B. 

Bothne R. H. B. Kibbler L. H. B. 

Comstock, Mason L. H. B. Cooper, Hamm R. H. B. 

Flippin , F. B. Hunter, Jebb. F. B. 

Capt. Majors has been out of the game for some time owing 
to an attack of rheumatism, and in the meantime McCormick has 
acted as captain. 

The P. & S. — Rush game which was to have been played, 
will be considered in the next issue. 

Could we winy well I should grin, 
We'd win the tin and blow it in. 
On P. & S. of— U. of I. 



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The Plexus. 276 

SENIOR NOTES. 

Frank Surridge, a member of the class of UtJ ', died on the 
15th, from crebro-spinal menmo^itis. His death was ashcckto the 
class and school, as very few knew of his illness. He entered the 
class only this fall, but even on this short acquaintance impressed 
ail that he was a gentleman. ';j The class sent a floral design and 
adopted the following appropriate resolutions: 

Whereas, God, in His infinite wisdom, has chosen to summon 
our fellow student, Frank Surridge, to his eternal reward; and 

Whereas, we his classmates, have. learned to know and admire 
him as a student and a man; and whereas, we feel most keenly 
for his family and relatives in this the hour of their sadness; be it 

Resolved, that we, the class of 1900, tender to his bereaved 
ones left behind, our deepest sympathy; and. 

Resolved, that the class attend in a body, and a copy of these 
resolutions be forwarded to his afflicted family, and that they be 

inserted in the College journal. 

( R. D. Scott 

Committee \ J. H. Xelowski 

( H. P. Mason. 



Among the many expressions of regret and sympathy from 
members of the faculty, in regard to the death of Mr. Surridge, 
the following communication was received from Dr. Harsha: 

Nov. 15, '99. 
President, Class 1900, College of Physicians and Surgeons: 

It was late this afternoon that I learned of the death of Mr. 
Surridge, a member of your "class. I was greatly grieved at the 
sad news, and wish to join with the class in their expressions of 
sympathy to the bereaved family. I have known Mr. Surridge 
for several years, and esteemed him very highly, as I am sure he 
was esteemed by your student body. Yours Sincerely, 

W. M. Harsha. 

The somewhat virulent epidemic of "Hay Fever" has at last 
been stayed in its progress. All the victims are convalescing.. 
There are yet a few sporadic cases, but at present there are ho 
fears of an endemic. 

Dr. Witherspoon wanted it understood that he didn't write 
the history. 



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One hundred' and sixteen free scholarships. 

Rluch Attention paid to Athletics. ■V Men and Women Admitted on Equal Terms. % The Best 

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on the Illinois River. % Pedagogical Department of Harked Excellence. 



The State of Illinois is behind this University, and will allow it to be second to none. Students 
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For catalogues or detailed Information, write W. L. PILLSBURY, Registrar. 

Two PostofBces, Address either Champaign, or Urbana, 111 



tSt'in'or Xdtcs. 277 

Dr. Yarros demonstrated, the obstetric art during Dr. Earle's 
absence, and, although it was a posterior position succeeded in 
delivering a living fetus. 

Members of the class will confer a great favor if they will re- 
port items of interest to the Editor. 

Rumors of an "exam" in gynecology caused an exodus from 
the front rows to the higher seats which command a better view 
of the black-board. The rumor was not well founded. We didn't 
get it. 

Dr. Name the bitter tonics. Hurst — Iron, quinine and 

strychnine. Dr . Next? 

Hummel terminated his course in maternity work by some 
practical experience with scarlet fever. At latest rej^orts he is 
doing well, and on the way to recovery. 

Madame Goodwin strenuously maintains her solicitude for 
the safety and comfort of the ladies. Such a degree of chivalry 
might possibly better grace the Knight of the 16th century, and 
in this case we believe is better in theory than in practice. 

Miss Winchell has given up her work in P. & S. to serve as 
interne in the Dunning Hospital. She passed the entrance ex- 
aminations with high grade, and enters on her work immediately. 
Great is Homeopathy. 

Parsons was anxious that nothing should interfere with hi& 
being present at the Caesarian Section. 

The sickness of our president necessitated the debut of our 
vice president as presiding officer. "Mony"' wasn't a bit rattled 
and discharged his duties with ease. 



JUNIOR NOTES. 

Prof. What is a rodent ulcer? 

Tilmont— -(Who had undoubtedly been out the night before) 
The conditions are of such a complicated nature that I am quite 
unable to give a satisfactory definition. 

As a "con-man'' Tilly is a glittering success. 

Dr. Ehrman and Dr. Sternberg do not seem to agree on tak- 
ing chances. 

Who is one of the boys? Or rather who would be? Will 
some one^kindly donate a pipe to the lady referred to? I think 
Soegard will furnish the tobacco. 



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The apartments are light and well ventilated 
heated by an improved hot water system. Hard 
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The operating room is especially fitted with 
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A competeat physician is in attendance at 
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(_'HANNiNG W. Bahkett, il. D.. House Surgeon 

For further information address 

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The Plexus. -21^ 

A gentleman of several aliases, such as Miss Tyvan and Carl 
.Smith is a member of our class. Boys watch him closely as I 
think he is a bad man. 

Mr. Ora M. Rhodes was elected to represent the Junior class 
on the staff of the lUini at Champaigne. 

A D. J. was picked up while in a semi-comatose condition 
just outside of the C. A. on the 31st. ult. He had been in to see 
Dr. Murphy operate. After he had "come to'" he said, by way of 
explanation, that he had been drinking too much sweet coffee for 
his breakfast (5 hours previous). 

Note of warning to D. J's. don't drink any coffee before going 
to a surgical clinic. 

A query: — Has Miss Wallen changed her name? 
Or does it still remain the same? 

Did any one discover Lennon's hair lip. If not it is too bad, 
as he got discouraged and had same removed by the barber. 

Officio I :~'Vh.Q gentlemen who participated in the L. A. rough- 
house recently, are requested to confine themselves and their en- 
ergies to the gymnasium during their moments of delirium, or 
else put on a football suit- 
Lost, Strayed or Stolen:— A bar of Colgate's toilet soap from 
267 South Lincoln st. We trust that finder will make good use 
of same and keep his face clean. 

Dr. Eisendralh has taken Dr. Harsh's place in the class on 
experimental surgery and will meet a section of about twenty 
each week to demonstrate all of the most common operations. 
He will also conduct a quiz on same. Notices will be posted each 
week of those on section and also naming the operations to be 

performed. 

Miss Brophy our congeniel surgical nurse has volunteered 
her services to assist us with our experiments. The following is 
a partial list of the oiDerations. 

Gastrotomy. 

Gastrostomy. 

Intestinal anastcmosis. 

Intestinal fistula. 

Operations on gall bladder. 

Empyema. 

Trachotomy. 

Thryoidectomy. 

Intestinal suturmg — this will be demonstrated on pig"s intes- 
tine . 




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Patients are treated at the clinics for the relief of functional disorders, e. g. 
insomnia, habitual constipation and enuresis, for neurosis, j^ain habits, hysterical 
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Students are given ample opportunity in these clinics to test their ability to in- 
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For terms and full information address the Secretary, 

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Ihe Plexus. 279 



SOPHOMORE NOTES. 

As a general proposition it is not to be wondered at that the 
co-eds had such a remarkable knowledge of the brain, when one 
considers the fact they had more brains to study. 

Why not have all the bearded men of the class sit in one row. 
It would lend a dignity to the class that would satisfy even the 
old time Greecians. Let Drs. Wilson and Coates take this matter 
up for consideration. 

Prof. — So what becomes of the capillary vessel? 

Student — It — a' — a' 

Prof. — ob — ob — ob-lit — 

Class. — obliterates. 

Student, yes-that's it, just what I was going to say. 

It is now a question of import as to the meaning of the soli- 
taire on the third finger of the left hand; said hand supposed to 
belong to Miss Day. 

Messrs . Beebe, Rodefield and Hammers are a trio of small 
men, but they demonstrate the fact that size cuts no figure in 
class work. 

It is indeed a matter of great regret that Miss Ingersoll is 
forced to leave college on account of ill health. 

Mr. Geo. Z. — As a rule we do not answer inquiries regarding 
marriage, compatibility etc. etc. but as your case is rather out of 
the ordinary we take pleasure in saying, if you really love the 
girl,^ — if you sigh for her, cry for her, if you could drink a river 
dry for her, 'vhy then, marry her, it would not cost so very much 
especially if pa and ma don't object. 

When it comes to making touchdowns, Dick Lockwood is the 
boy who gets there. 

H. O. Shafer and C. O. Wilfong are room mates. It comes 
very nearly having the horse and cow lying down together, rath- 
er than the lamb and lion of which the Good Book speaks. 

To my patrons; I have again resumed my former name of 
J. C. Tyvand.— H. W. Smith. 




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The Plexus. 280 

FRESHMAN ITEMS. . 

The D. J"s still exist; but Dr. Butler has been sick. Meloy 
took unto himself a wife, the rest of the class took the cigars. 
Dr. — What is a Synergist? Fisher: anyching that promotes waste, 
therefore always take casteroil with synergist. 

Fusick and Sibley represent the D. J's. in the mandolin club. 

Smith skipped class and got a hair cut. Mr. Fitzgerald the 
anatomical wonder demonstrated before the class the other morn- 
ing. 

We are glad to see Mr. Lamb around again, he has been in 
the West Side Hospital three weeks with a severe attack of 
pneumonia. 

Silverberg promises once more to pay attention and Dr. 
Eckley goes on with the quiz. 

The following question was given Dr. Butler by one of the 
sophomores who is specializing in Materia Medica. "Has 
broncho- pneumonia anything in common with horses?" Will 
some senior kindly answer his question? 



NEWS ITEMS. 



The Antikamnia Co. are now placing upon the market a 
new combination of drugs in tablet form which will fill many a 
prescription blank with precisely what is indicated. They term 
them the "Antikamnia Laxative Tablets'" and the "Antikamnia 
and Quinine Laxative Tablets," and the component parts of each 
certainly make them appeal to the general practitioner. 

Dr. L. Harrison Mettler, Professor of Physiology has a very 
scholarly article in Werner's Magazine for October entitled "The 
Poetry of Science." 

The clinical laboratory is receiving a thorough renovating 
and is being separated into two parts by a partition — one for Dr. 
Coates and post-graduate work — the other for students. By the 
change more students will be accomodated and the room will be 
more sytematically arranged. 



PR03PIXTUS UF THE COI.LEGE. 

The eighteenth aumial course ui instruction Avill begin the third Tues- 
day in September, 1899. tind will continue seven monthh, closing- the third. 
Wednesday in April. 1900, with the public commencement exercises. 

Ill addition to the regular "Winter session the College offers a Spring- 
session of two and a half months. The Spring session ot 1900 will begin 
April 20, 1900, and end June 30, 1900. During the course about one-third of 
the Winter session is gone over and credits are given for the work done. 

REQUIREMENTS FOR ADMISSION. 

Every candidate for admission is required to present credentials as 
follows : 

1. A certificate of good moral character from two reputable physicians. 

2. A diploma from a recojriiized colie2:e, academy, or high school. Students una- 
ble to meet i iiis reiiulrement are admitted on passing a satisfactory examiuatioa in 
the foUowiiv^j subjeiJts : 

(o) H njilish : The writins; of an essay of at least two hundred words upon a se- 
lected siibjecr. Goldsmith's "Vicar of Wakefield" will furnish the Ijasis of the exami- 
nation in English for this year. 

Oj) Physics: The principles of mechanics and hydraulics. Deschanel's Natural 
Philosophy, fart I, is recommended in preparation. 

(c) Mathematics: Arithmetic and algebra; plane geometry, as given in Wells' 
or Wentworth's Geometry. 

id) I-atin grammar and an examination in translating Latin into English from 
"Ca>s:ir's t'ommentaries." represcntinu- at least two years' study of Latin in im accred- 
ited high school. One year will l)e allowed in which to jemedy defects in Latin. 

Tlieppitrance examination will Ije conducted in writing, under the dire -lion of 
the President oi the University, by a committee outside tu"^ Faculty of the Medical 
School, and will be held at the College at lo a. m., on the Mondays preceding the open- 
ing of the Winter and Spring terms. Diplomas and other credentials shoiiki Repre- 
sented at that time. 

PLAN OF INSTRUCTION. 

The instruction is arranged in four distinct annual courses. The col- 
legiate year consists of a Winter term of seven months, and a Spring term 
of two and a half months. Attendance upon the Spi'ing term is optional. 

EQUIPMENT. 

The College building is a six- story structure on the corner of two wide streets, 
with an open space around it on all sides. It is heated by steam and provided with all 
modern conveniences. It contains tliree well-lighted and well-ventilated amphi- 
theatres, the •mallest of which seats two hundred students. 

Adjacent to the College buildiuLc on the west is the Laboratory, a structure re- 
cently built by thtrCollege and fully eiiuipped for all kinds of laboratory work. The 
Laboratories contained therein are among the largest and mostcomplete possessed by 
any medical college in tlie United States. They occaipy tour flooi's, and each will ac- 
commodate 1-20 students at a time. They are provided witli desks and lockers for each 
student. Adjoining the laboratories aie preparati<Mi rooms for the use of demonstra- 
tors and professors. There is also a bone room to wliifli students have free access for 
the study of osteology. In the department of i)Mthol()gy tlie pathological collections 
furnish ample materials for tlie macroscopical as well as the microscopical study of dis- 
eased tissues. Tlie storerooms are connected with all ihe laboratories by means of an 
elevator. In the instrument roum are thirty-one first-class Lei'z microscopes, and 
forty-three Bausch & Lomb microscopes of continental patterns, besides foity micro- 
scopes of various other manufactuiers, all for the use of students. The College has 
also sixteen Bausch & Lomb microtomes, besides microtomes of large size and special 
construction for particular kinds of work. 

C'LiNtCAL Facilities. The Dispensary occupies the first floor and a portion of 
the second floor of tlie main building. Connected with the reception room are fourteen 
for clinical instruction. During the past five years there have been treated in these 
rooms an average of 30,000 patients each year. 

Obstetrics. In this department the student is taught practical obstetrics ■by- 
means of demonstration (women in labor) before the class, and by attendance upon 
cases of confinement at the homes of tlie patients and in the West Side Hospital. 

The Collego has also recently established an olistetrical clinic for the purpose of 
giving students practical lied side experience in obstetrics. This clinic issituated with- 
in a convenient distance of the College. Iiut in one of the most densely populated parts 
of Chicago, and the amount of obstetrical material available for instruction is equal to 
all demands upon it. A physii'ian and nurses are In attendance day and night, and, 
under their direction, senior students will be given the care of obstetrical cases. In- 




GF.dKOK F. UUTLKR. Pli. G.. M. 1). 

I'rofi'ssoi- of Matciiii Medicaiind Oliniciil Mt'dkiiu', ColltK^- of 

Fliysiciiiiis unci f^urt^eoiis. Chiesigo. 



THE PLEXU 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 

UNIVERSITY OF ILLINOIS, 



VOL.V. DECEMBER 20th, 1899. NO. 8". 



WHAT ARE WE HERE FOR?" 



A PLEA FOR MORE ENTHUSIASTIC STUDY OP O^HERAPEUTIGS'. 



George F. Butler, M. D. 

"Give me truths, 

For I am weary of the surfaces 

And die of inanition. If I knew 

Only the herbs and simples of the wood, 

And I could surely spell 

Their fragrance, and their chemistry apply 

By sweet affinities to human flesh 

Driving the foe and 'stablishiog the friend, — 

Oh I that were much. 

But these young scholars who invade our hills 

Love not the flower they pluck, and know it not, 

And all their botany is Latin names." 

—Emerson's Blight. 
The mind hungers for principles. 

For years the cry has been "Give me truths" and the master 
minds of our profession have devoted their lives to the trac- 
ing of possibly a single symptom once called a disease, back to- 
the law of its origin. 

Refined and scientific diagnosis, pathology, bacteriology, 
and antiseptic surgery are some of the fruits of these men's labors. 

It is a satisfaction to have lived in a generation when medi- 
cal science achieved its greatest victories when it proved the law 



282 The Plexus. 

which alike controls the b'rth, growth, decadence and death of a 
monad or a planet, that law suspected, guessed at, but never com- 
prehended until recently when it became known that when an or- 
gan or a part of any living entity hesitated in its work that 
moment the destroying forces attacked it and did not rest from 
their labors day nor night until they had taken it to pieces, re- 
duced it to its simplest elements, and restored them to the com- 
mon dejoository for use. 

The workmen in this process were once called decomposition 
and decay. We know them now as the living laborers, the un- 
builders of nature. 

These countless millions are some of the enemies with which 
medical science has to contend. 

To obstruct their work, arrest their mysterious reproduction, 
and eradicate them from the human body is the Herculean task 
committed to our profession. 

Our advance has been marked by more triumphs and greater 
victories than in any other department of human endeavor, yet 
in the scientific application of remedies to disease the progress 
has not been so great. We have been filled with enthusiasm in 
scientific pursuits, it is true, but like the mountain climber who 
has heard of the entrancing scene spread out before those who 
reach the height, struggles up over walls of rocks, and obstruc- 
tions of varied character, overlooking everything in his mad de- 
sire to gain the summit. So the physician fascinated with the 
disclosures of the microscope, and the study of pathology and 
bacteriology has overlooked to a large extent the important sub- 
ject of Therapeutics. 

Diagnosis, 1 admit, is absolutely necessary in order to treat 
disease intelligently; yet there never was a wiser, more truthful 
utterance regarding medicine than that of Amedie Latour, who 
said: 

"Genuine medicine has deviated from its natural paths; it 
has lost its noble object, that of curing ur alleviating. By thus 
acting it has rejected therapeutics; yet without therapeutics the 
physician is nothing more than a useless naturalist, passing his 
life in discovering, classifying, and describing human diseases. 
It is therajjeutics which elevates and enobles our art; it alone 
gives it an object; and I may add that by it alone can this art be- 
come a science." 

Pathology and Diagnosis are of the utmost importance to the 



W/iat are we here for? 283 

physician but of no special value to our patients unless we can 
relieve their suffering by proper treatment. 

Turn to any text book of Practice of Medicine. There are 
pages devoted to etiology, pathology, symptomatology and diag- 
nosis, and but a meager space allotted to treatment. 

If every student would make an exhaustive investigation of 
one single drug, studying its action from every standpoint what 
a fund of knowledge we soon would have! 

While it is true there has been developed in these directions 
much which is of value to mankind, the knowledge is so meager 
and in such a discordant condition as to render it imperative for 
others to review the work. 

The chemistry and action" of opium even, are not yet thor- 
oughly understood, although it has been subjected to years of 
conscientious investigation. 

We are as yet working in an unknown, and almost limitless 
field. Our intellect fails to comprehend the possible actions of 
the countless substances that influence vital action and thus mod- 
if3'- disease expression. 

But few of the chemical compounds that may exist, have 
been produced as yet. Our own native flora holds treasures that 
await the discovery of some zealous investigator and there still 
remain thousands of plants in the partly unexplored regions of 
Africa and South America yet to be studied: many, for aught we 
know, possessing as great medicinal value as opium, cinchona, 
digitalis and nux-vomica. It has been well said "that every plant 
and new synthetical compound bristles with interrogation points." 

The study of pharmicology and therapeutics should be an 
inspiring one, occupying, as it does, the disputed ground between 
health and disease, life and death. 

Mankind anxiously awaits the discovery of surer remedies 
for diseased conditions, and there is no special line of investiga- 
tion in medical science more worthy, or more pregnant with liv- 
ing facts and awe inspiring themes. 

Humiliating as the admission may be, we stand dumb before 
the mysteries of the vast majority of the vegetable, animal, and 
synthetical medicaments. 

While hundreds of able men are devoting their lives to the 
study of etiology and pathology, can there not some one be found 
who will labor to pla^e therapeutics upon a higher and more ex- 
.act plane, and thereby better aid the jjhysician in accomplishing 



284 Tne Plexus. 

the real object of his chosen profession? It is pertinent to ask 
here! 

"What are we here for?" 

Drugs were formerly, and even now are by many, 
looked upon as simple substances or specifics capable of 
curing disease, but wa kaowthit tliay ar3 complex substances, 
affecting textural and functional changes according to certain ele- 
ments which they contain, and the manner in which they are 
combined. Why digitalis should stimulate the heart and aconite 
depress it is unknown. 

Can the subtle alchemy by which out of the same elements 
one iDlant yields bread and another poison be recorded in the bar- 
baric language of retorts and cruicibles? Yet we are enabled to 
foretell in many cases what the effects of a certain combination 
of elements will be on the human organism and it is possible by 
the aid of chemistry to so modify the composition of remedial a- 
gents as to transform them into compounds having very different 
pharmacological effects. For example Fraser and Crum- Brown 
demonstrated many years ago that by replacing an atom of hy- 
drogen in Conine by one of methyl (CH.) its properties were 
greatly changed. Conine paralyzes the nerve endings alone, the 
methyl compound depresses the spinal cord. By the substitution 
in sulphonal of a molecule of ethyl (C2 H5) for a molecule of 
methyl, trional is formed, which appears to have in some cases a 
better effect than sul phonal. 

Sodium acetate possesses very slight action, but if one atom 
of hydrogen in the acetic acid is replaced by bromine, the result 
is mono-bromo-acetate of sodium having a powerful action upon 
muscle tissue, rendering the muscles of a frog so rigid that it be- 
comes like a piece of wood. Phenol and aniline are both ex- 
tremely poisonous but orthoamido-phenol is innocuous. 

We know, moreover, the general effect or characteristics of 
certain series. For example, it is probable th;it all the sub- 
stances belonging to the alcoholic series possess the power of a- 
bolishing to a greater or less extent the excitability of the various, 
nerve centres, although different compounds vary in their mode 
of action, some being more useful as hypnotics others, owing to^ 
their quick action and raj^idity of elimination, being employed as 
anesthetics. 

In the aromatic group, so called, are found our most efficient 
analgesics and antipyretics, such as acetanilid, antipyrine, phe- 



What are ice here forf 285 

nacetin, etc. Even morphine, an alkaloid of opium, acts upon 
birds as a powerful antipyretic. 

By boiling morphine in water, acidulated with hydrochloric 
acid, apomorphia is formed, by heating it with soda and methyl 
iodide it is converted into codeine. Pilocarpine may be changed 
into jaborine, a substance resembling atropine in its pharmaco- 
logical effects, if heated with dilute hydrochloric acid. 

These few illustrations are given to show that it is possible 
within certain limits to prepare medicines in the laboratory which 
may reasonably be expected to produce certain definite effects. 
Yet it must be remembered that if the properties of remedies are 
so easily altered outside the body, they may be as easily changed 
within the body. Yet the action of particular drugs on the sys- 
tem is moderately constant. 

In the treatment of disease, we assume in each case, quoting 
from Dr. Leech, either (1) that in diseased conditions there is nat- 
urally a return to health, or (2) that if the apparent cause of the 
ailment be removed cure will follow, or (3) that b}^ the restora- 
tion of tissues and organs, which are the special seat of patho- 
logical changes, to their normal textural and functional state, or 
to a condition approaching the normal, we promote cure; and 
further, that w^hen organs are caused by drugs to resume their 
normal function, their improved condition may continue even 
when the drug is withdrawn. We endeavor, therefore, to select 

a drug to fulfill one of the following indications a drug which 

will (a) so influence some organ or organs as to avert the tenden- 
cy to death, (b) remove the apparent cause of the ailment, (c) re- 
store as far as possible the tissues and organs, which are the spe- 
cial seat of pathological changes, to a normal state. In addition 
to these indications we are manifestly called upon to (d) relieve 
pain and suffering. 

It is apparent that in one sense indication c includes a, and 
b. In averting death or removing the apparent cause, however, 
we do not necessarily deal with the special seat of pathological 
change. We always meet indication a, at once, and then indica- 
tion b if we can. 

Space will not permit me to elaborate on these indications 
which would convince the therapeutic nihilist, that this subject is 
worthy of more careful consideration on the part of the medical 
profession. 

What honest and unprejudiced physician can deny the value 



286 The Fhxus. 

of the antitoxins, thyroid and suprarenal extracts, or the value- 
of mercury, iodine, opium, arsenic, ergot, digitalis and strych- 
nine, and of the anesthetics, antiseptics, antipyretics and hypno- 
tics? 

We know that such drugs as chloral, belladonna, physostig- 
ma, and nux vomica act on the tissues of certain parts of the 
brain and spinal cord, and thereby increase or decrease the func- 
tions of those parts. We can depress the functions of the motor 
nerve endings with conine, and the sensory nerve endings with 
aconite. We can paralyze the involuntary muscle fibres directly 
with the nitrites, or indirectly by chloral hydrate, which depress- 
es the functions of the vaso-motor center. We can stimulate or 
depress the functions of cardiac muscle, and dilate or contract 
the blood-vessels. The tissues of the various glands may like- 
wise be stimulated or depressed. We can improve the nutrition 
and therefore the function of almost all the tissues, by iron, cod 
liver oil and lime; and indirectly we can produce the same eifect 
by the f^astric tonics and digestives which promote the taking^ 
and absorption of food 

Dr. Albert Abrams in a paper entitled "The Employment of 
Drugs in Diagnosis," alludes to the administration of certain 
drugs as a means of diagnosis. Amyl nitrite for instance relieves 
anemic headaches and intensifies those of hyperemic origin. 
Migraine of spastic origin is relieved whereas paralytic migraine 
is aggravated. He claims that the phenomena of auscultation 
are in many instances brought out after inhalation of amyl 
nitrite. 

The antitoxins are of value as a means of diagnosis, in diph- 
theria, cryptogenetic septicemia, hydrophobia, etc. 

Anesthetics are invaluable often in the examination of joints- 
and to determine whether tumors, contraciures, etc., aredue to hy- 
steria. Arsenic is of value in aiding a physician in the diagnosis, 
of many neuroses. It is also an efficient aid in excluding tuber- 
culous adenitis from Hodgkin's disease. 

The diagnostic value of atropine in ophthalmic medicine is- 
well known, colchicum in gout, potassium iodide in neuralgias, 
ulcerations, paralysis, etc., of suspected syphilitic origin, intoxi- 
cation from mercury, lead, zinc, etc., and in actinomycosis. Qui- 
nine in intermittent fever; salicylic acid in a typical manifestations 
of jiresumable rheumatic origin; salol for determining the motor 
activity of the stomach. Thyroid feeding constitutes an invalu- 



What are we here for? 287 

able diagnostic means in the recognition of all cases of myxe- 
dema, whether the disease be the true form, sporadic cretinism, 
or cachexia strumipriva. Thymol is especially destructive to the 
parasite of anchylostomiasis and is of undoubted value both as a 
means of diagnosis and cure. 

Therapeutics implies more than the mere administration and 
local application of drugs. 

Climate and artificial aero therapeutics or medicated atmos- 
pheres are often important adjuncts in the treatment of disease. 

Balneology and Hydrotherapeutics are immensely important 
and are increasing in popularity and deservedly so. This sub- 
ject alone requires our most careful thought and investigation. 
It is wonderful what results may be obtained by the proper use 
of water externally or internally or both. 

Equally important are the medical applications of electricity. 
No less an authority than H. Lewis Jones, says there is no man- 
ner of doubt that electrical currents produce detinite physiologi- 
cal effects. The most obvious physiological action of electricity 
is its power of stimulating living tissues. The metabolic activity 
of the tissues can be considerably increased by electricity, as 
Gantier and Larat have shown in their experiments upon the 
elimination of carbonic acid gas and urea under electrical treat- 
ment, when it was found that an increase of 40 or 50 per cent, 
could be produced by general electrification. 

Massage or "Mecbano-therapy"' is another invaluable means 
of treating many diseases, particularly when applied by an ex- 
pert. The practice of massage by people quite ignorant of med- 
icine, certainly with no scientific training, and independent of 
proper diagnosis and directions from a physician, is altogether to 
be deprecated, and is one of the great sources of the prejudice 
against the method still existing in the minds of medical men. 

I must not fail to mention "Suggestive Therapeutics." The 
fact that the condition of many patients is influenced favorably 
or otherwise by their mental condition is well known. 

The Christian Scientist and Faith Curist unquestionably ben- 
efit many people. There is a large element of truth in their 
practices, and the physician who fails to recognize this, will see 
many of his patients drift into other hands. 

Drugs are rot all that is necessary in the treatment of dis- 
ease, and one is a very narrow therapist indeed, who seeks for 
no means of relief outside of a drug store. There are Kmits to 



288 The Plexus. 

the utility of drugs, and the want of belief in them is largely due 
to the fact that they are expected to achieve the impossible. 

What may be good therapeutics in one case may prove injur- 
ious in another. The practitioner who masters all of the meth- 
ods I have named, that are useful in the treatment of disease, 
and adopts the most untrammeled, rational procedure will gen- 
.erally be rewarded not only by generous patronage, but even 
more by the respect and confidence of the medical fraternity and 
the approval of his own conscience. 

I believe with Brunton that the prospects of therapeutics are 
Tery bright. "I think it is highly probable," says Brunton, "that 
before long we shall have a series of drugs which will stimulate 
the biliary secretion of the liver or modify its glycogenic funct- 
ion, arranged in order of their comparative strength, in much the 
;same way we now have the class of antipyretics. We may also 
iairly expect to obtain a series of remedies which will act upon 
the spinal cord in such a way as to enable ns to treat a number of 
diseases which are at present altogether beyond the reach of our 
remedies." 

The grandest principles that challenge human investigation 
center round the subject of Therapeutics. Let us master every 
phase of it, that we may be better enabled to relieve our suffer- 
ing patients. It is to be hoped that the therapeutic researches 
of the present generation will be followed by yet more brilliant 
achievement, and by its light the darkness of passing illusions be 
happily dispelled. 

"What are we here for?' 



RECENT PROGRESS IN BACTERIOLOGY. 
By Dr. Adolppi Gehrman. 

Read before tHe Chicago Academy of Sciences, Oct. 24, 1899. 

It is true that every one is not willing to admit that bacteri- 
ology is a science. By many persons it is still thought of as the: 
germ theory and meetings are occasionally announced for a dis- 
cussion of the germ theory. 

Although all the important knowledge regarding bacteriol- 
ogy has been learned during the past twenty years, the number 
of startling discoveries have not been as numerous during the 
past four or live years as in the period from 1880 to 1895. At 
present new facts are obtained with greater difficulty and the in- 
vestigators' field of research is becoming so complex that consid- 
erable experience is required to even follow the experiments. 
New possibilities of the practical application of bacteriology are 
constantly appearing and the field of study is now so wide that 
the student who wishes to accomplish anything at all must confine 
himself to some very small part of the subject. 

I have arranged the material at hand under the headings of 
Progress as Related to Bacteriologic biology, to methods of ex- 
amination, and in relation to the arts, and in medicine and in 
Sanitation. 

The study of bacterial cells themselves has not produced 
many new facts. There have been no marked improvements in 
the microscops daring the past ten years. Th3 individual cell is 
therefore nearly as far away as it was to the first observers. It 
is now admitted, however, that tlie protoplasm of bacteria is al- 
most entirely of a nuclear nature, with but a small film of proto- 
plasm about the nucleus. Some facts have been ascertained 
showing the tendency to pleomorphism among the bacteria. 
Recognizing this has helped to clear away many of the apparent 
contradictions in early observations. Through the observations 
of Plexnor and Hill, the discovery of modified forms of tubercle 
-and diphtheria bacilli give additional proof of the close relation 



290 The PI exits. 

of the bacteria to the mould plants and therefore further estab- 
lishing that bacteria are plants. 

New facts as to the distribution of bacteria are being 
learned. During one of the recent polar expeditions bacteriolog: 
ic observations were made- These showed an almost entire ab- 
sence of bacteria in these regions. Bacteria werecnltivated from 
sea water but not in great numbers and it is proposed that those 
found on shore and in ice came from the sea. The air was fre- 
quently found entirely sterile. Examination of the intestinal 
contents of the animals killed was made and- showed those of birds 
to be free from bacteria. The intestines of several polar bears 
that were tested showed some bacteria but not as numerous as in 
animals further south. In regard to the condition found in the 
birds we have additional knowledge to disprove the proposition 
that the presence of bacteria in the intestinal canal is necessary 
for digestion. 

The distribution of bacteria in sea water has been studied by 
almost every scientific ocean expedition. Bacteria are found in 
all the oceans but are most numerous from one to two feet below 
the surface down to a depth of twelve to fifteen feet; at great 
depths not many are found. 

The effect of sunlight is given as a reason for the smaller 
numbers at the surface. 

The chemistry of bacteria is being studied by numerous ob- 
servers and the results indicate that there are still unknown pos- 
sibilities in organic chemistry. 

Ehrlich's observations on the action of tetanus poison upon 
nervous tissue are interesting. When the poisonous products of 
the tetanus bacillus come in contact with brain tissue a combina- 
tion with the albumen of the brain cells takes place. This new 
product is more poisonous than the original tetanus poison. The 
action between poison and brain tissue take place either in the 
living body or after death. Many of tlie facts of this disease are 
explained through these observations and from a chemical stand- 
point the possibility of albumen combining with other substances 
is established. These combinations are called "seitenketten'" by 
Ehrlich. 

In the methods of examination of bacteria there have not 
been any radical changes or improvements recently. However, 
the tendency is to simplify everything so that now a large ])art 
of the work is comparatively easy, when compared with the 



Progress in Bacteriology. 291 

methods first devised. In this commotion, however, it is firmly 
established that the reaction of culture media must be uniform 
and carefully adjusted. The experiments of Mr. Fuller have giv- 
en origin to what is called the Massachusetts scale for reaction 
of culture media. Many of the discrepancies in bacteriologic ob- 
servatons have been due to differences in culture media and it is 
now the intention to have all bacteriologists work alike. 

Bacteriology is assuming great importance for the agricul- 
turist and farmer. It has been found of value to him in assisting 
him in the preparation of the soil for his crops; in the conversion 
of some of his products as in the making of butter and cheese; in 
the diagnosis of dis-^ases among his animals, and the discovery of 
its origin; and in the treatment of animals and prevention of in- 
fectious disease. Max Hoffman in a recently published hand 
book on this subject places the material at hand in most conven- 
ient form for the use of farmers. 

The activities of bacteria in the soil are of great importance; 
they stand between living and dead matter, converting the for- 
mer after it has completed its function in life in such a manner 
that it can again be utilized by future generations of plants and 
animals. The principal activities are in the directions of break- 
ing down the complete molecules of organic substances into sim- 
ple combinations, NH^ CO 2 H, N CH^ and HSg and in fixing val- 
uable elements as nitrogen in the soil. 

There is a marked symbiosis between some plants and certain 
varieties of bacteria. The recent introduction of Nitrogin and 
Alinit in Germany have given an impetus to this line of investi- 
gation. 

These two substances, Nitrogin and Alinit are bacterial fer- 
tilizers that have the power to assist plants of the starch produc- 
ing varieties to grow more luxuriantly and produce considerable 
larger quantities of their valuable constituents. Nitrogin assists 
leguminous plants by making CO, more easily assimilated. Ali- 
nit acts much in the same way towards wheat, oats, rye and other 
grains. Experiments in pots show that grains planted upon poor 
sandy soil to which alinit is added yield three or four times as 
much grain as those without its assistance. 

The practical experiments of Frank, Berthelot and Wino- 
gradski show an increase of 40 per cent, in the growth and pro- 
duct derived from oats and wheat. The bacterium essential to 
alinit has been called Bacillus Ellenbachensis. Other varieties of 



292 ■ The Plexus. 

bacteria have been isolated, the action of which is almost entire- 
ly confined to isolating" ammonia from organic matter. 

The nasent ammonia combines with sodium and potassium 
and nitrates are produced. These remain in the soil and are later 
acted ujDon by denitrifying bacteria or those that separate NH3 or 
even the N from the sodium or potassium. 

Another recently open field of investigation regards the fer- 
mentation in wine making. Wortman has been working on this 
subject and has found that different species of bacteria and yeasts 
cultiv^ated from the soil in the Rhine district, and from the wine 
vats in localities where specially good wines are produced, are 
the chief agents in the development of a fine wine. He has 
claimed that cider can be converted into any kind of wine depend- 
ing upon the varieties of organisms used in its fermentation. 

A recent statement from the U. S. Agricultural Department 
says: 

"The use of artificially-bred yeast for red wines has been a- 
dopted extensively of late, and laboratories in Switzerland, as 
well as in France, are putting these bottled fungi on the market 
in large quantities. It is found desirable to employ for each kind 
of wine its own peculiar germs — for example, Burgundy yeast 
for Burgundy, and so forth — rather than to mix them up. Each 
species of fungus seems to patronize by preference a particular 
sort of grape juice, and does not do such good work when applied 
to any other sort. The contents of each vat are sterilized by 
heat before the fluid culture is put in. 

In dairying bacteriology is assisting by spreading knowl- 
edge of the cause of failure in producing the desired result and 
in teaching cleanliness. 

Considerable knowledge concerning the bacteria causing dis- 
ease and the prevention of these diseases has recently been dis- 
covered, but there has been nothing of a startling character; the 
investigations have mainly thrown light on disputed points, and 
have established certain facts already known. 

Among bacteria causing disease the Bacillus of influenza and 
of yellow fever are being accepted as the essential agents in 
these diseases. The observations of Dr. Reed that place the yel- 
low fever bacillus in the hog cholera group of bacteria are impor- 
tant. The recent observation by Klein in England, and Class in 
I his country regarding the micrococcus of scarlet fever require 
further investigations to render them conclusive. 



Progress in BactcrioJor/j/. 293 

In regard to the transmission of disease, much is being pre- 
sented and some of the subjects are very interesting. Simond 
found during his investigations in China and India that the mode 
of spread of Bubonie plague tal^es place from man to man and 
from rat to rat. Spreading of the disease over large areas is 
mainly caused by man, while extension over small areas is caused 
by the rat. The intermediary agent between infected individuals 
and the healthy, are fleas. Roux has shown that rats and other 
rodents may be infected by rubbing infectious material upon their 
noses. Yersin has verified these observations. It is now clear 
that the fleas infect one rat after another, and when the rats die 
the fleas find a new host, and if not at once finding a home upon 
a furry animal they may lodge upon man and infect him through 
their bite. The infection from man to man in the absence of v< r- 
min is miminal as is shown by the records of well organized 
plague hospitals. 

Rats without fleas may be infected by caging them with im- 
mune rats having fleas, or by jDlacing fleas in their fur. The 
plague, therefore is a disease that is not to be feared in a sanitary 
locality but is extremely dangerous in a dirty, vermin-infected 
district. 

Recent observations as to .the transmission of malaria are 
very interesting. Major Ross of the East Indian service found 
in an examination of the mosquites about the camp where he was 
stationed, that portions of their bodies, especially that part 
about poison sacs and along the lymph channels, were at times 
filled with malaria-like organisms. He has also found malaria 
organisms in the blood of sparrows and was led to experiment as 
to the possibility of infecting them from mosquitos. Sparrows 
were obtained from England, the blood of which was free from 
malaria. Infected mosquitos were placed in cages with sparrows 
and infection of the birds promptly resulted. His recently re- 
ported observations in the British Medical Journal shov/ that 
sparrows having malaria may infect malaria-free mosquitos, and 
these in turn malaria free sparrows, when the three are caged 
together. 

Nuttall, of Berlin, has reviewed all of the work along this 
line and substantiates the results. The facts are valuable in in- 
dicating means for prevention and in showing the important re- 
lation that insects bear to the propagation of diseases. Pe'ro- 
lum is now spread over marshy land in order to kill the larval 



294 The Plexus. 

mos mosquitos. Among other interesting observations may be 
mentioned some relating to seruir diagnosis. 

Serum diagnosis in diphtheria has been studied by Bruno, 
who linds that agglutination or clumping of the diphtheria bacil- 
lus takes place with the blood serum of diphtheria patients or 
those immunized against the disease. The reaction, however, 
does not appear early enough or remain constant so that the test 
as a means of diagnosis can supercede the methods of examining 
throat cultures. 

Kraus and Seng report observations upon the mechanism of 
agglutination in the serum test for tyiDhoid fever. They reach 
the conclusion that the phenomenon is caused by precipitation of 
albuminous constituents that act as a coagulum sticking the bac- 
teria together. They base their opinion upon the effect of other 
substances in causing agglutination, ascinnebar, ultramarine and 
alcohol. The change that takes place among the bacteria is 
therefore dependent upon the presence or absence of substances 
capable of causing this precipitation. 

Seium diagnosis with the Bacillus icteruides in yellow fever 
is an established fact. Archinart, of New Oi'leans, reports ob- 
servations regarding this subject. His conclusions are: 

1. The practical application of serum diagnosis in yellow 
fever is established. 

'2. It appears about the second day of the disease and may 
persist as long as nineteen years after an attack. 

3. To make the results certain the serum should be diluted 
1 to 40 and the reaction should appear in one hour. 

4. Dried blood may be used. 

5. Arrangements for making the test should be at hand in 
all localities where yellow fever may occur. 

6. The diagnosis is especially valuable in the beginning of 
epidemics when other diseases might similate yellow fever. 

Recent progress in bacteriology of sanitation and preventive 
medicine has been important. The observations of Pleugge, 
Klebs and Godstein have shown that the particular source of in- 
fection in surgical operations is due to the spraying of small 
particles containing infectious material that may come either 
from the breath of those present in the room or from the splash- 
ing of infected water. Plates containing culture media were ex- 
posed in various portions of the operating room, and persons in 
other parts of the room coughed, sneezed and splashed water. It 



Progress in Bacteriology. 295 

was found that the number of bacteria that grew upon the places 
was in direct proportion to the severity of the coughing or to the 
strength of the currents of air passing in that direction. An In- 
teresting review of this subject has recently been published by 
Dr. Clausen. Out of this has developed further and more stringent 
methods as to the prevention of infection in surgical operations. 

The action of sunlight upon bacteria has been receiving con- 
siderable study in England. Observations on the water in the 
Thames show that strong sunlight rajDidly decreases the number 
of bacteria at the surface, and that its action is marked to a 
depth of 15 to 18 inches. 

In regard to general methods of disinfection, the introduction 
of formaldehyd has caused a most important change from the 
older methods. The action of this substance seems to be pecul- 
iarly detarmlnei to ba3teria. The effect, apparently, is brought 
about through the fact that the bacteria are single cells and that 
the formaldehyd can therefore rapidly enter in contact with their 
structure. In the case of higher animals or j^lants, which are 
not as readily killed as bacteria, the failure to obtain an etfect is 
due to the combination of the formaldehyd with substances on 
the surface of the cells without destroying those in deeper layers. 
Formaldehyd is therefore recognized as the most certain and 
powerful surface disinfectant known; but its penetrating j)owers 
are limited owing to its alteration in passing through various 
substances. 

In our own work in the Department of Health formaldehyd 
is used exclusively as a disinfectant and its reliability is evi- 
denced from the effect it has upon cultures and test objects ex- 
posed in apartments under treatment. 

In closing this summary cf more important work that has 
been done in bacteriology during the last few months, I can only 
say that every advance that is made opens up a field of wider 
and wider range; but places the investigator in the same position 
as the chemist, who is making investigations along his particular 
line. We are obliged to follow so closely such a small portion of 
the entire subject and so little can be accomplished even with the 
most painstaking and long continued experiments that sudden 
and startling observations, such as the early observations of 
Tyndal, Pasteur and Koch, are not to be expected . 

103 State Street. 



CARDIAC AND BRONCHIAL ASTHMA— A STUDY IN. 
DIFFERENTIAL DIAGNOSIS. 

By Alfred C. Croftan, M. D., Pasadena, Cal. 

Cardiac asthma, as the name implies, is produced by a patho- 
logic action of the heart. Bronchial asthma, so-called, is caused 
by disturbances in the innervation of the bronchial and bronchi- 
olar musculature. The symptomatology of the two forms is su- 
perficially similar; for prognosis and rational treatment it is es- 
sential that we should know with which form we are dealing. 
The difficulties that are universally encountered in the treatment 
of asthma may in a large measure be attributed to negligence or 
inability on the part of the physician to clearly differentiate the 
cardiac and bronchial forms. 

Whenever an engorgement of pulmonary capillaries occurs,, 
the walls of the alveoli lose some of their elasticity and breathing 
becomes difficult. Such an engorgement will occur when the 
blood-pressure in the aorta either rises or falls; for a rise of arter- 
ial pressure, when caused by vasomotors stimulation, produces a 
rise of pressure both in the aorta and in the pulmonary artery 
and as a result distention of the alveolar capillaries (von Basch). 
Wheu, on the other hand, the blood-pressure falls, an engorge- 
ment occurs in the venous system, the lesser circulation, the 
right heart and the pulmonary artery (accentuation of second pul- 
monary sound) — and the alveolar capillaries are again distended; 
in both instances we have "cardiac" dyspnoea. If the individual 
is otherwise normal, the muscles of inspiration and expiration 
can in a measure compensate the defect, and whatever hinders 
this muscular compensation will in its turn favor the occurrence 
of the dyspnoea; thus a weak development of the muscles of the 
thorax in reduced individuals, or a hindrance of their action in 
excessively fat subjects, further mechanical hindrances to the 
free excursions of the diaphragm as distention of the stomach or 
intestines with gas, ascites, abdominal tumors, etc., can all In 
part bo made responsible for an attack of cardiac dyspnoea. To 
produce a true attack of cardiac asthma excessive work must 
suddenly be thrust upon the heart, producing either a paresis or 
a spasm of the heart-muscle; in either case the result will be the^ 




ALFRED C. OROFTON, M. D. 
Late Assistant Professor of General Diagnosis and Clinical Instruoto 
of Diseases of the Chest. College of Physicians and Surgeons, 
Pasadena, California. 



Cardiac and Bronchial Asthma. 297 

same, viz.: a distention of the left auricle of the pulmonary ca- 
pillaries, rigidity of the alveolar walls in consequence and 
dyspnoea, i. e. , ca7'd/ac asthma. 

The symptoms of cardiac asthma are self-evident from the 
above viz.: The dyspnoea comes on suddenly, and is both in- 
spiratory and expiratory in character, breathing is slow, the pa- 
tient cyanotic. The pulse may be full and bounding at the onset 
of the attack; during the attack, however, it is soft and small 
(pulsus debilis). Percussion, in view of the distressed condition 
of the patient, is as a rule impractical — the results obtained, viz. : 
enlargement of the pulmonary boundaries and diminution of the 
cardiac dullness do not give any differential clues of value. It is 
important, on the other hand, to auscultate, as the absence of rales 
and of bronchial breathing is pathognomonic for this form of 
asthma. 

The etiology of bronchial asthma is rather obscure; a catarrhal 
condition of the bronchial tubes, as in chronic bronchitis and 
emphysema may obtain, which by peripheral irritation of the 
nerves supplying the bronchial musculature may lead to spasm; 
(an analogy to the spasmodic contraction of other organs in 
which an inflammation of the mucosa leads to muscular spasms, 
viz. : spasmodic stricture of the sphincter vesicae or ani in vesical 
or rectal irritation, spasm of the orbicularis in irritation of the 
conjunctiva, etc.). In cases where the lungs are normal, more 
remote peripheral causes in the nose and throat are capable of 
producing the spasm. The removal of hypertrophied tonsils, of 
turbinates, of polypi, etc., has in many instances led to a cure of 
the asthma. If the respiratory organs and tracts are normal 
such remote peripheral irritants as intestinal parasites, pelvic 
disorders, etc., can, it appears, by distant reflex action be made 
responsible for attacks of bronchial asthma. Cases are further 
frequent in which the cdor of certain i)erfumes, the pollen from 
certain plants (hay- asthma), etc., may produce an attack. In rare 
instances a lesion of the vagus nerve has been shown to be re- 
sponsible for asthma. It is well, therefore, in every instance to 
examine the patient for enlarged lymph-glands, aneurysm of the 
vessels of the neck, or other lesions that might press on the 
vagus. Those forms of asthma which follow in the train of a 
nephritis (asthma urasmicum), of a gastritis with distention 
(asthma dyspepticum) of lead intoxication (asthma saturninum) 



298 The Plexus. 

are as a rule cardiac, as has been shown above. The place of the 
so-called uric acid asthma is not clearly defined. 

While the etiology of bronchial asthma is obscure the symp- 
tomatology is very clearly marked and the diagnosis easy. 
Periodically the patient is seized with violent attacks of dyspnoea 
accompanied by cyanosis. The dysi^noea is very marked and 
chiefly expiratory in character— expiration lasts about twice as 
long as inspiration, and in consequent the total number of inspira- 
tions and expirations is not increased, usually, in fact, diminished. 
Expiration is accompanied by wheezing and groaning. On per- 
cussion the boundaries of the lungs are found to have increased 
by several intercostal spaces downward, the cardiac dullness is 
diminished and may be obliterated. A percussion note as in 
emphysema is heard (bandbox-nots). On auscultation Rhonchi 
sibilantes are heard all over the chest, principally on expiration; 
toward the end of the attack rales of all kinds are heard and a 
typical sputum is expectorated. It is frothy, grayish -white and 
contains little plugs; under the microscope these plugs are seen 
to consist of leucocytes, alveolar cells, hemosiderin (from minute 
hemorrhages) and Charcot's crystals. The pulse is small but 
bounding, owing to the dyspnoic character of the blood. Stork 
has made a tracheoscopic examination of a patient during an 
attack of bronchial asthma and reports a hyperaemic reddening 
of the larynx and trachea toward the end of the attack; this may 
account for the appearance and constitution of the sputum. 

The only disease with which such an attack of bronchial 
asthma can be confounded are spasm of the glottis, siKism of the 
diaphragm and cardiac asthma. 

Spasm of the gltotis can be readily diiferentiated if we consider 
the inspiratory character of the dyspnoea, the violent movements 
of the larynx, the inspiratory retraction of the epigastrium, the 
brief duration of the dyspnoea and the absence of acute disten-r 
tion of the lungs. .., 

In spasm of the diaphragm, inspiration is spasmodic, the thorax 
remains in the inspiratory position for several seconds and re-- 
sumesthe expiratory position suddenly; the epigastrium pro^?-i*des, 
during the inspiratory spasm. 

The differentation from cardiac asthma may be facilitated by 
the following scheme in conjunction with what has been said 
above. : . • .* 



Cardiac and Bronchial Asthma. 



299 



Dyspnoea: 

False: 



Percussion: 



CARDIAC ASTHMA. 

Inspiratory and 

Expiratory. 

First, full and strong, 

later, small and soft. 

(pulsess debiles). 

No typical sound. 



BRONCHIAL ASTHMA, 

Expiratory. 

Small and bounding, 
(pulsus parvus et celer). 



Auscultation. 



Sputum: 



Absence of abnormal 
breath-sounds. 



Sound as in Emphysema, 

(bandbox-note). 
First, Rhonchi sibilantes, 
later, large and small 
rales all over the chest. 

No sputum, unless Typical grayish- white, 

pulmonary oedema frothy sputum, with 

supervenes. yellow plugs, 

If a careful differential diagnosis in the above sense is made 
in'every case of asthma, therapeutic intelligently directed to a 
removal of the true cause in each individual case will usually be 
crowned by success. 



•-OOii 



?f-.si.- 



"OUR WIVES." 

The following response to the toast "Our Wives," was de- 
livered by Dr. George F. Butler, at a banquet given by the 
Chicago Society of Internal Medicine in honor of Dr. J. George 
Adami of Montreal, at the Auditorium Hotel, on Thursday even- 
ing, November 30, 1899. 

It was a chivalrous tribute to a lovely woman paid by our 
present ambassador at the Court of St James when, being asked 
what distinction he would prefer were he not already raised to 
eminence, he turned to his wife and answered gracefully, "I 
should wish to be Mrs. Choat's second husband." So happy was 
their wedded life, so rich in mutual regard and confidence, and 
the wealth of devotion compared with which titles and the world's 
homage seem but trivial affairs. 

Who of us, gentlemen, cannot echo the glowing praise so 
feelingly oestowed? Yet if there be among us one, who still 
meanders aimlessly along the solitary path of so-called single- 
. blessedness, let him depart from our midst, forthwith — he is not 
of us, nor can he comprehend well-nigh the only solace known to 
the physician's life of toil and anxiety. He cannot know the 
strength that cheers the young country doctor, urging his flound- 
ering steed through midnight darkness and the wintry blizzard, 
when "black care sits behind the horseman, " and his mind is 
filled with foreboding reflections. He cannot feel the blessed 
thrill that wakens in the traveller's thoughts as he discerns at 
last the light of home, the lamp of love that is to him his spirit's, 
beacon. He cannot know, this desolate wayfarer, the kindly 
glance, the speech of loving encouragement and benediction of 
sweet trust that render heroic the struggle with adversity which 
looms before the young practitioner, nerve and sustain him in his 
noble endeavor, and warm the very cockles of his heart. He 
cannot know the infinite comfort of that brave helpmate in mo- 
ments of desperate encounter with fate, in hours of thoughtful 
solicitude, when, but for the guidance of that ministering angel 
at his side, all his years of privation and study must have seemed 
a thankless sacrifice, and ambition but a luring delusion of 
irony. He cannot feel, when fortune at length smiles upon the 
faithful servant to mankind, he cannot experience the joy of 



Response to the Toast "Our Wives.'' 301 

kuowing there is someone to be gladdened by his laurels, some- 
one to share his pride and sweeten the consciousness of honorable 
achievement. He cannot know, this solitary man, how, when the 
steep has been laboriously climbed, and, in place of an enchant- 
ing landscape, only the desert of disappointment lies before his 
bewildered vision, when the blight of mediocrity has withered the 
fair flower of hope, he cannot know how tenderly precious it is 
to feel that there is one to cross hand in hand and heart to heart 
with him that barren waste; to take courage with him at sight of 
the charming oasis that rises like a castle in the air, in unattaina- 
ble mirage, and long with him to quench the thirst of years be- 
neath its spreading palms. And when the mighty shadow of the 
unseen casts the penumbra of its dread eclipse upon the days 
that are departing, and he who has watched many a fellow mor- 
tal pass within the solemn portals, must himself answer the sum- 
mons of the recording angel's voice— this unattended, perchance 
unloved, pilgrim cannot conceive the happy calm of an abiding 
affection, endeared by the most sacred earthly bonds, which is, 
as it were, the new guest's passport to heaven, commending him 
to the celestial repose which broods over eternity. 

No, no! imagination cannot picture, knowledge cannot com- 
pass, nor experience fashion in the mind of the celibate the trans- 
cendent worth of woman's love. Its influence is none the less 
potent because exercised gently; its inspiration none the less 
vital because of the finer sensibilities from which it springs. The 
man of business enjoys the counting-room and the exchange; the 
votaries of other professions, the enthusiast in music, art or lit- 
erature, are sustained by the fervor of their several pursuits; the 
scientist, roams his empire of intellectual power with the dignity 
of royal prerogative — the physician, only the physician, finds his 
lot saddened by the ever-recurrent consciousness of human suf- 
fering, treading the sombre aisles where are gathered the world's 
afflicted, while others walk in the rich sunlight of life, knowing 
no sorrow save their own. 

How then shall this almoner of heavenly pity, whose heart is 
human- -yes, intensified, not calloused, by professional experience 
— bear the constant strain upon mind and nerves? How endure 
with equanimity the thought of being the depositary of all these 
earthly woes, and bravely meet the fearful responsibilities im- 
posed upon his conscience by the forlorn hopes of fellow-men? 
Only through the perennial fragrance of woman's affection, and 



3<e . The Plexus. 

the unfailing rememberance of a hearth-stone whose fire forever 
burns brightly, and a cheery light of conjugal happiness that 
shall efface the recollection of human tragedy. 

Cicero, in his beautiful essay upon "Friendship" declares 
that, were he to ascend to the empyrean and behold all the glory 
and majesty of the universe, that sight would be unsweet to him 
were there none near to whom he could impart his emotion. Even 
so the physician, overpowered by the mysteries that haunt the 
abode of mortal disease, dwelling ever amid the inscrutable mis- 
ery it is his sorrow ,as well as his joy, to alleviate, would shrink 
from the contemplation of a life so burdened with care and pain, 
were it not that fate has blessed him with the tranquil memory of 
one bright image ever present to dispel his spirit's gloom, one 
benignant sympathy ever lovingly responsive to his own. 

Now-a days, it is the fashion to disparage the [constancy and 
admiration of man. The social tendencies of the times have orig- 
inated an elaborate club life, which women are 'too apt to consid- 
er a reflection upon the value of their own society. Let them not 
fear. A business or professional life is at best a wearing tread- 
mill, and if man finds relaxation in the society^of his fellows, as 
a rule the home is ever present in his thoughts, and as surely as 
the loadstone attracts to itself the particles of iron, so surely 
does the blessed circle of domestic comfort and happiness draw 
homeward the heart whose deepest affections center in that hal- 
lowed refuge — though it be towards the "wee, sma'hours" — and 
the entrance suggestive of burglars in the back pantry. 

What can we do to prove our faith and honor? 

Gentlemen, how can we do too much for them,. "Our Wives,'' 
whose tender care is the inspiration of our lives y 



VENTRAL HERNIA FOLLOWING DRAINAGE OF ^ 
ABSCESSES IN THE REGION OF THE 
APPENDIX. 

By Henry J. Brugge, M. D. 

The occurrence of ventral hernia following drainage of peri- 
appendicular abscess, a sequel so disagreeable to the patient and 
humiliating to the surgeon, has done much to mar the otherwise 
brilliant record of surgery of the apj)endix. Indeed, so frequent 
has been the occurrence of this undesirable result that a subse- 
quent operation, having as its object the removal of the appendix 
left in situ at the time drainage of the abscess was instituted and 
the radical cure of the ventral hernia, has become a recognized 
and frequently practiced procedure. 

In formulating a plan of treatment best calculated to avert 
the occurrence of a ventral hernia, naturally we must first con- 
sider the causative elements in its production. 

The principal factors much favoring the subsequent existence 
of locus minoris resistentae at the point of operation are: — (1) vio- 
lent movements and straining, (2) neglect of maintenance of the 
recumbent posture for sufficient length of time, (3) retraction of 
the deep fascia, (4) partial prolajDse of an intestinal coil, and (5) 
the existence of a wide thin scar following the operation. 

Considering the first two mentioned, little need be said. The 
important role they play, and the way in which they act prejudi- 
cially must be obvious to the reader. 

In order to prevent undue retraction of the deep fascia, ac- 
curate coaptation of the edges up to the drain on each side, by 
means of separate interrupted absorbable sutures, is strongly ad- 
vised, or even in spite of the infected field commonly existing and 
which would apparently argue against the procedure, early union 
usually takes place. 

One of the most important elements in the production of Br 
ventral hernia, favoring as it does the formation of a wide, thin, 
adherent scar, is partial prolapse of an intestinal coil. Early in; 
the case, after removal of the gauze drain, the wound should be 



304 Veyitral Hernia. 

daily inspected by the surgeon in order to detect any tendency" 
toward the recurrence of this complication and when a coil is seen 
to be approaching the surface the necessity of packing the wound 
more firmly, until it becomes deeper and navicular in shape and 
has firm walls of granulation tissue, is obvious. 

After curetting the edges, the wound can be now closed by 
interrupted silk-worm-gut sutures, or where this is inconvenient 
the opposing surfaces can be brought together by adhesive strips 
and early closure will follow with the production of a narrow, 
deep, strong scar. 

At the end of convalescence, the existence of a broad thin, 
scar with a tendency toward bulging, when intra-abdominal ten- 
sion is increased, argues well for the early formation of ventral 
hernia; still, much can be done by ordering the patient to wear a 
close fitting supporter. Indeed this last precaution is important, 
as in all cases the line of incision is a comparatively weak spot 
and stretching of the scar tissue is common, subjected, as it is in. 
this position, to frequent tension. 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 
UNIVERSITY OF ILLINOIS. 

Editor, H. C. WADDLE, '03. Business Mgr. G. G. DOWDALL, '00 



Class Editors: 

H. B. HAMILTON, '00. CHAS. M. NOBLE, '01. PAUL E. GRABOW, '02. 

GUY C. WAUFLE, '03. 



Faculty Department, Dk. W. A. 1'usey. Athletic Editor, A. DONKLE, '01. 

Alumni, Clinical Department, E. A. Gansel 

Publishers. ...... DOWDALL & WADDLE. 

Subscription $1.00 per Annum in advance. Single copies, 13 cents. Issued Monthly 
-Send all romiltances and communications ai to subscriptions and advertising to G. G 
DOWDALL, Business Manager, 813 W. Harrison St. 

Entered at Cliicajio Post Office as Second-Class Matter. 

Any subscriber desirinsc the Journal discontinued at the expiration of his subscription 
should so notify tlie Publishers; otherwise it will be assumed tliai the subscription is to be 
continued and the .Journal sent accordingly. 



Contributions of matter suitable for publication are invited, and should he sent in not 
later than the 35th of the month previous to that of publication. The publishers willnot hold 
themselves responsible for the safe return of MSS unless sufficient stamps are forwarded 

EDITORIALS. 
In the April issue of the Plexus will app<?ar a Table of Con- 
tents for the fifth volume of the Plexus. There has been quite 
a demand for this as quite a few of our readers desire to have 
the Plexus bound in book form. Did you notice that the last 
Plexus was the largest one you ever received? It was. 

* * 
* 

The young doctors, and old ones too, will find a powerful 

le.ver of assistance in their practice by a liberal use of diplomacy 

mixed with due care and attention to what are generally termed 

"the lesser things of life." In the first place, careful attention 

should be paid to the wardrobe — dress plainly, though well, a 

smooth shave, polished shoes, clean linen and a neat fitting suit 

of nice quality of cloth wins the respect and confidence of 



306 The Plexus. 

the patient, a thing absolutely necessary for success in the prac- 
tice of medicine. What is of even more importance than dress^ 
however, is to always tell the patient the truth, or if the question, 
cannot or should not be answered directly, then the physician 
should use circumlocution and that tactfully, too. Be prompt in 
all your appointments to call agam — by being there on time or a 
few minutes ahead of time, you will couvey to your patients the 
belief that you are a man of your word, and then when you give 
medicine and say it will help them, they will believe you and 
their belief is of much benefit in aiding the medicine to do its 
work. The medicine is essential and necessary to an early resto- 
ration to health of the patient, but when the medicine is sup- 
ported by full confidence of the patient in the doctor, the good 
work is much more rapidly and satisfactorily done. 

* 
The mini published by the students of the State University 
at Champaign under the eyes, if not the auspicies of the faculty 
of the State University of Illinois, publishes conspicuously the 
advertisement of W. Frank Ross, who claims to be an A. M., 
M. D., D. O. What degrees this W. F. Ross has really taken we 
do not know — but we do know that his advertisement shows him 
to be a fraud, a quack, and a full-fledged montebank, and ought 
to be criminally prosecuted for obtaining money under false pre- 
tenses, and the student managers of The Illini open themselves to 
severe criticism, and it is a question whether they should not also 
suffer prosecution as jiarticeps criminis with him. The faculty of 
the State University are direlect of duty in not drawing the line 
on these gross insults to every intelligent citizen that reads the 
paper. Their neglect brings odium upon the educational institu- 
tion from which they derive their bread and butter, and the 
sooner W. Frank Ross is prevented from further prostituting the- 

advertising columns of The Illini the better for ail concerned. 

* » 
* 

"Col. W. Dowdall, the veteran editor, has purchased Carter's 
Monthly, a high grade literary magazine, published in the 
Rand McNally building^ Chicago, and will re-enter his life-long 
profession — ^journalism. 

Col. Dowdall as editor and proprietor of the Alton Daihj 
Democrat in 1862 made a home for himself as an able publisher- 
and journalist, and at Peoria for a quarter of a century he occu- 
pied a high position in state and national politics as an able^ 



Editorial 30r 

writer and newspaper publisher. If the Colonel succeeds as well 
in magazine pursuits as he did in politics and newspaper work, 
the success of Carter'' s Monthly is assured. 

Associated with him will be Opie Read as editor, assisted by 
the most able magazine writers in the country. No money will 
be spared in making Carter's Monthly the leading literary maga-' 
zine in the West. In order to give it a world wide circulation 
it will be mailed to any address in the United States at the low 
price of ^1.00 per year; single copies ten cents." 

The above was clipped from one of the newspapers of the 
state. Col. W. Dowdall is the father of our rustling business 
manager, Mr. G. G. Dowdall and the Plexus wishes Col. Dow- 
dall well in his new undertaking and predict for him the success 
which has been meted to him in his editorial work of the past. 

Through the efforts of Dr. W. S. Christopher, Member of 
the Board of Education, of Chicago and Instructor in Children's 
Diseases at the College of Physicians and Surgeons, the Board 
of Education has taken a very important step, the importance of 
which can not, at the present time, be well estimated. 

Through Dr. Christopher's efforts the Board of Education 
has determined to apj^oint fifty medical examiners of the public 
school children, at an annual expense of 'f 20, 000. 

These medical examiners are to be regular practitioners and 
are to pass examinations given by the Board of Education. The 
first of these examinations was held on Dec. 9th, with over 300 
applications. These offices will come under the Civil Service offices.' 

The subject of Medical Inspectors for the public school is 
not altogether a new one, as the city of New York employs 150 
medical inspectors at an annual expense of ^^187,000, but it is a 
subject that should receive the careful attention of every school 
board in the Unitad States, the greater the city, the greater the 
need of the medical inspectors. 

The health of the pupils is of far more consequence than the 
mere acquisition of knowledge and should demand more atten- 
tion, and it is the duty of the Board of Education to place such 
environments about the pupils as to reduce to the possibility of 
becoming infected by the many contagious diseases, to the 
minimum. Without medical inspection, jDarents allow their chil- 
dren infected with scarlet fever, diphtheria, etc., lo enter school,, 
thereby exposing the other pupils of the school. 



^08 The FJexiis. 

Under the plan adopted by the Board of Education, pupils 
absent from school, for four days or more, will have to be 
inspected by the medical examiner before entering their classes. 
The Board will then be doing the duty of the parent, which 
is so often neglected, because of some whimsical notion of the 
parent, to the detriment of the community at large. The fact 
that there were over 1,000 cases of infectious diseases reported 
among the school children of Chicago the first two months of 
this school year only shows the great need of this very important 
step by the Board of Education. 

If the health department would now look to the enforcement 
of rules with reference to the placarding of all houses wJiere 
these infectious diseases are located, the community would be 
better off. 

* 

Dr. George P. Butler, Instructor in Materia Medica in the 
College of Physicians and Surgeons, who writes the leading 
article in this issue of the Plexus, has resigned his editorship 
of the Medical Standard and, with the first month of the new 
year, will bring out a new medical magazine of his own. 

It will not be the organ of, or aifiliated with any school or 
society but will be entirely free from lay influences. It is to be 
a monthly magazine devoted to the best interests of the medical 
profession and the public health. 

The high standing and well known ability of Dr. Butler, as 
an author and editor, assures us of the excellence of this maga- 
zine and the Plexus, as well as the many friends of the College 
of Physicians and Surgeons, will welcome the appearance of 
this new journal and will aid in its success io every way possible. 

* 

* * 

The best medical authorities agree in the opinioa that loud, 
continued, tumultuous noises in a great city are injurious to 
health, often producing insanity to the nervous, and death to the 
invalid. All will admit it is a great nuisance which should be 
curbed as much as circumstances consistent with business inter- 
est will permit. The Buffalo Medical Juurnal is agitating the ques- 
tion in that city — looking to the abatement of the nuisance as far 
and fast as possible in New York. The Plexus voices the sen- 
timents of thousands of Chicagoans in calling atteniion of the 
Chicago Board of He ilth to this matter complied with a request 



Editorial. 309 

that they give the subject due consideration and prompt atten- 
tion. 

The London (Eng.) Medical Press and Circular in speaking of 
the work of the London Society says: "The life of the average 
citizen is becoming more tolerable, so far as street noises are con- 
cerned, a happy state of things which is due not to the fact that" 
he has become accustomed to such nuisances, but because the 
streets are quieter than they used to be. In a certain measure a 
good influence has been exerted in this direction by the London 
Society for the Suppression of Street Noises. Although only in 
the second year of its existence, the society, as its report for the 
past year shows, has been steadily pressing forward an admirable 
campaign against the soul-disturbing costermongers and news- 
boys, who make the thoroughfares hideous with their yells and 
howls. Moreover, it is satisfactory to note that the society has 
a well-designed program in the pursuit of which its members in- 
tend to expend their best energies. For example, among their 
objects of reform are included the compulsory fixing of India- 
rubber tires on all vehicles, floors of the same material for milk- 
carts, the establishment of kiosks in place of the screeching 
newspaper boys. But even if all these reforms were successfully 
attained, many more noises would still be left to be dealt with. 
The bawling coal hawker, for instance, is an intolerable nuisance 
and the irritating, expressionless, metallic clang of the barrel 
organ should be banished altogether from the streets. Possibly, 
however, when the London Government Act comes into force, 
marked improvement will be noticed in regard to the prevalence 
of street noises, inasmuch as the new municipalities have been 
empowered to make by-laws for regulating and suppressing such 
nuisance, and there is every reason for supposing that full ad- 
vantage will be taken of the clauses in the act relating thereto." 



vDlinlGal IDeparbmenb. 

COLLEGE OF PHYSICIANS AND SURGEONS. 
E. A. Gansel. 

CESAREAN SECTION. 

That the Chicago College of Physicians and Surgeons is the 
■scliool of schools for variety of clinical material was again mani- 
fested on November l-sth when Profs. Carl Beck and F. B. Earle 
performed a Cesarean Section. The operation was performed in 
the clinical amphitheater of the college in the presence of a num- 
ber of prominent obstetricians and surgeons not connected with 
the college, the members of the faculty and as many of the stu- 
dents as were fortunate enough to secure seats or standing- 
room 

The history of the case was as follows: Mrs F. C, aged 21 
years, admitted to West Side Hospital, Nov. loth, '99. 

Family Hisfjyry — Father, mother, one sister and two brothers 
living and well. One sister dead due to an accident. Personal 
History — Usual diseases of childhood. When nine years old had 
an abscess in left side of neck which was opened, and discharged 
pus for some ten months. When eleven years old had an abscess 
in the left groin which was operated on and discharged pus for 
about a year. Has otherwise been well. Menstruation began at 
fourteen, has always been regular, lasts three days, is painful 
for first day after flow starts, flow normal. Has been married one 
year and a half. Last menstruation began Feb. 25th, '99. First 
felt foetal movements about the last of June. Has never been 
troubled with morning nausea or vomiting. Appetite good, bow- 
els regular, no urinary disturbance. 

Physical Examination — Height 4 ft. 8 in., weight 95 pounds, 
marked deformity of spine. Abdomen very pendulous, umbili- 
cus, being just about on a line with the symphysis pubis. 

Pelvic measurements: — 

Intertrochanteric — 26i cm. 

Intercristal — 24 cm. 

Interspinal — 21 cm. 



Clinical Department. 311 

Baudelocque — 16 cm. 

True Conjugate — 6i cm. 

Operation— IncisAon in median line about eight inches long 
over prominent part of fundus. Fundus of uterus exposed and 
drawn out through the opening. Abdominal incision now closed 
beneath the fundus as nearly as possible with silkworm gut su-^ 
tures. Lower uterine segment grasped and firmly compressed. 
Incision in transverse direction over the fundus about on line 
with uterine cornua. Membranes ruptured, seven pound girl de- 
livered, cord clamped and cut. Uterus briskly massaged, thus 
expelling the placenta and membranes. 

Utei-us contracted rapidly and hemorrhage was very slight. 
Incision in uterus now closed with three layers of sutures as fol- 
lows : 

1st row — including mucous membrane and slight hold on 
muscular coat. 

2nd row — serous surface with about one half of the muscular 
wall. 

yrd row — an interrupted Lembert suture infolding the suture 
line. 

Uterus replaced in abdomen and abdomen closed with in- 
terrupted sutures. Time of operation forty minutes. 

Course: — Both mother and child in excellent condition after 
the operation. Mother made an uneventful recover^^, and both 
left the hospital in perfect health on December 5th, seventeen 
days after the operation. 

PSEUDO-HYPERTROPHIC MUSCULAR PARALYSIS. 

Prof. King during the past months has shown a large num- 
ber of interesting cases at his clinics. At his clinic on December 
6th he presented a family of six children, five of whom to a great- 
er or less^extent manifested symptoms of the above disease. 
These children were all American by birth but of Scotch descent 
with a marked predisposition to the disease inherited from their 
mother. Three or four of the mother's brothers and sisters have 
either died of this disease or are at present suffering with it. 
More distant relatives also had the disease. 

C~ The father was present at the clinic and is a healthy and in- 
teilligent man. The mother is thirty-four years of age and al- 
though she^attends to her household duties, rather appears as 
though she^were suffering slightly from the same malady. The 
following is a brief history of the six children: 



312 The Plexm. 

I. Boy aged 13 years: — Learned to walk during infancy, but 
gait was always waddling and awkward. The arms at that time 
were perfectly normal. Gait became gradually more awkward 
until six years ago, since which time he is neither able to stand 
nor walk. Now spends all of his time either lying down or in 
sitting up with the knees in extreme eversion, while the feet are 
as markedly inverted. Mind and expression of face dull, has not 
learned to read. Face very full and round. Tongue double the 
normal thickness (a symptom not usually given in the literature) 
Antero-posterior as well as lateral curvature of the spine. Hips 
much enlarged. Sexual organs not developed. Muscles of calves 
very much hypertrophied, but they possess no strength. Feet in 
marked equino- varus position. Legs are completely -paralyzed^ 
arms very much so, and growing worse. The muscles have a 
doughy feeling but sensation is good, in the limbs there is no 
pain or numbness. Circulation in extremities is fairly good. Re- 
flexes all gone. 

Prog. — Will very likely not live another year. 

II. Girl aged 12 years: — Can not bring left foot to less than 
a right angle with the leg, also turns out somewhat. She is bright 
and otherwise apparently well. 

Prognosis — Will probably herself escape but is liable later to 
transmit the disease to her male children. 

III. Boy 10 years: — No awkwardness in walking or running. 
Calves a trifle enlarged. Doughy area above both ankles — 
somewhat harder than in 13 year old boy. Left foot is slightly 
turned out. Mind bright. 

Prognosis — May live. 

IV. Boy 8 yea rs — Stands with legs far apart, shoulders thrown 
back, spine curved and abdomen protruding. In getting up from 
the floor he beautifully illustrates Gower's figures by "climbing 
up his legs." In running he is very awkward and raises his arms 
with every step. Muscles of calves are of stojiy hardness and en- 
larged, gluteals also somewhat enlarged. Arms very thin, fore- 
arms and hands normal. A little tendency for feet to roll out. 
Bright mentally. 

Prognosis. — Will probably follow same course as 13 year old 
boy. 

V. Girl 6 years: — Apparently perfectly free from the di sease. 
A bright and very pretty child. 

Prognosis — Quite likely will escape the disease. 

VI. 5a&?/ 7<? mon^/i.s.-— Muscles of calves already very hard. 
Prognosis — Almost positive that will die of the disease. 
Treatrrvint — Electricity, massage, strychnine ^^^ g\ gr. hy- 

podermatically, keep up the nutrition. 



. CLINICAL LABORATORY DEPARTMENT. 
W. E. CoATES, M. D. 

Clinical Lahoralorij Beport. — 

Since the present system of laboratory index and history 
cards was inaugurated, over two hundred recorded examinations 
of urine, sputum, pus, bloo 1 and tissue have been made in the 
laboratory. In point of numbers, the list of tissue examinations 
leads, which is rather surprising when we consider the large 
number of medical cases in which the examination of the urine, 
blood, and sputum would shed light on the patient's condition. 

The greatest difficulty we have to contend with is not lack 
of material but lack of forethought on the part of the clinical 
staff, manifesting itself in the habit of sending material to the 
laboratory unaccompanied by a history of the case, often the 
name of the physician sending the material is not even known. 
If the material is worth examining at all it is worth doubly as 
much if the examination and report is intelligently made, and 
this cannot be done where important facts are not plainly stated 
on the history card. 

The work of the Clinical Laboratory as outlined in the Sep- 
tember Plexus has been partiallj'^ carried out in spite of many 
obstacles that have had to be met and overcome. Ten students 
are now regularly at work on the first three courses of study and 
the number of those who drop in for an occasional hour's work 
for the college clinics is increasing. 

Dr. Murphy's plan of turning over material for laboratory 
examination to students of his class, requiring them to obtain 
the history, make the examination and report the same at the 
next clinic, is a valuable innovation and is to be recommended, 
as it combines the clinical and laboratory study of a case in a 
way that teaches the practical value of both. 

Research Work.— The work of the Research Department has 
been confined largely to the study and investigatioa of tumor 
growths by the Director of the Clinical Laboratory and his. 



314 The Plexus. 

assistants. Results so far obtained warrant our belief in a pre- 
liminary statement that certain forms of tumors, both malignant 
and benign, are parasitic in origin, that diiferent parasitic fungi 
produce diiferent tumor growths; these parasitic fungi are prob- 
ably closely related to low forms of parasitic Phycomycetes, 
Ascomycetes, Fungi Imperfecfi, the lower Basidiomycetes, and 
l^ossibly the fungus allies -the Myxomycetes. It our con- 
clusions prove correct, these parasitic fungi are derived from 
forms originally parasitic on plant life, but which have acquired 
the power of living parasitically on animal tissue and there pro- 
ducing lesions similar to those so common in the realm of 
vegetable pathology. 

We do not believe that attempts to cultivate these parasitic 
fangi will be uniformly successful until the question of the relation 
of an intermediate host or hosts to tumor growths is determined. 
The amount of material available to the Clinical Laboratory 
for research work on the parasitic origin of tumors may be 
judged from the fact that we have tissues, and histories of same, 
from more than fifty cases obtained from the college clinics 
since September, of this year. To properly utilize this 
material, at least one month's study should be given to every 
tumor examined; culture experiments should be continued with 
every jDOSsible variation in the methods, both old and new. The 
laboratory is open to any student, undergraduate or graduate, 
who is fitted by previous training for research work of this kind, 
and every possible effort will be made to encourage such work. 

Blood Work. — The increasing demand for blood work and the 
recognized value of this too often neglecled field of laboratory 
work warrants an effort in this direction during the remainder of 
the college year. 

Blood work cannot be successfully carried on without suit- 
able cases, and to this *end we would earnestly request the 
clinical members of the faculty to send their cases to the labora- 
tory for examination. The laboratory is now equipped with 
blood instruments, and students desiring to follow this line of 
study can be accomodated. 

Laboratory Improvements.^ — The improvements promised 
for the Clinical Laboratory last June have only partially mate- 
rialized up to date, to say the least. 

The plans and specifications for these much needed improve- 



Ctinical Lahoratory De^jdrlmtnt. 315 

ments appear to have been lost sight of, over-looked, pigeon- 
holed, or laid on the table by the building committee to which 
they were referred after (to quote Prof. King on college politics) 
the change of administration. After weeks of patient and im- 
patient waiting, weeks of mingled hope and fear over the fate of 
long cherished plans of improvements, weeks of delay and 
inconvenience in carrying on the work of the laboratory, tlie 
building covniii(/ee of the Clinical Laboratory has made improve- 
ments of such a nature as to permit the work of the laboratory 
to continue uninterrupted for the remaining months of the 
college year. 

The laboratory, as now equipped, will provide working spaces 
for fifteen students who desire advanced work in urinalysis, 
blood examination, bacteriology, etc., as outlined in the Sep- 
tember Plexus. 



ATHLETICS. 

WAS RUSH JUSTIFIED IN CANCELLING THE 
GAME WITH P. & S. 

One of the most exciting and interesting games of the season 
which was to have been played Nov. 17th between P. &S. and Rush 
was cancelled, it is said, by the Athletic Committee of Rush. The 
statement of Mr. Arthur Dean Bevan, chairman of the faculty 
committee, is as follows: 

"As chairman of the faculty Committee on Athletics, I can- 
celled the game with P. & S. which was scheduled for Nov. 17th. 
This action w^as taken in the interest of clean college athletics. 
To give or receive directly or indirectly compensation for playing 
on a foot- ball team is professionalism of a character which could 
not be countenanced by the Rush authorities. It is to be hoped 
that this action will be productive of good and that next year no 
reason will exist to prevent the annual P. & S. and Rush game." 

For the benefit of those who think that Mr. Everett is in fault 
with regard to the cancelling of the Rush game little need be said, 
except that this game was definitely arranged as is proven by 
the statement of Mr. Bevan. 

According to the above statement, Rush charges P. & S. 
with professionalism. Are they justified in doing so? No, — 
not any more than we are justified in charging Rush with profe s 



316 The Plexus. 

sionalism. In the first place, they cancelled the game wiihout 
even stating that they would play us if we would play absolutely 
bona fide students. Secondly, they can not prove that each and 
every man on their team is a bona fide student. Thirdly, can they 
prove that we have men who are receiving compensation for play- 
ing and that we have professionals on our team. No, — Now 
if the Rush authorities can not prove these statements what right 
had they to cancel the game. Every year since P. & S. has had 
a team they have defeated Rush and they could have done so this 
year. 

If the reasons for cancelling the game were justifiable, we 
would not feel as we do, but so long as this annual game has oc- 
curred for the past few years it seems that it is a disgrace to Rush 
Medical College to retreat rather than meet their opponents. 
Even many of their own students think that the game was can- 
celled because they thought that defeat lay before them. 

Rush certainly has no right to claim that they could have 
won because they have never defeated P. & S. since P. & S. has 
had a team. Furthermore, P. & S. has by far a better record for 
the past season than Rush, which is shown by the following 
statements. 

No. of points scored against P. & S. 12. 

" " " " " , Rush 53. 

" •' " '-' by P. & S. 121. 

" " " " " Rush 39. 

These statistics and the record of P. & S. in previous years show 
the comparative strength of the two teams. They have been out- 
classed by P. & S. in the past and they would have been def eated_ 
this year had they played us. 

Rush has acted unfairly and has won nothing by it and 
furthermore, their actions will not be productive of the good re- 
sults next year as their athletic committee desire. 

p. & S. WIN BY SMAl^L SCORE 

The game between Notre Dame & P. & S. resulted in a final 
score of 5 to 0. It was rather a decisive victory for P. & S. 
P. & S. played a snappy and quick ga,me while Notre Dame were 
rather slow. The work of Cory, Hassett and Bothne was excep- 
tionally good 



'A I LI rp pi Beparbmepb. 

'83. Jas. Watson Wood, Long Beach, Cal. 

'83. W. B. Abbott, Pinconuing, Mich. 

'84. Royal M. Curtiss,, 1043 N. Broadway, Balthnore Md., is 
now taking a two years Post Graduate course at Johns Hojjkins. 

'84. Archibald Church, Pullman Building, Chicago; Prof, 
of Clinical Neurology and Mental Diseases, and Medical Juris- 
prudence at North Western University Medical College. 

'86. H R. Cronlc, 27 E. 30th St., New York. Assist. Sur- 
geon N. Y. Eye and Ear Intirmary — Attending Surgeon, N. Y. 
Throat and Nose Hospital. 

'8fi. J. Kayzer, Plymouth, Ind. 

'80. Elias Miller, 11460 Indiana Ave., City. 

'83. Allen Bell, Eaton, Ohio. 

'86. J. J. McClellan, Columbus, Ohio. 

'86. J. H. Bertrand, De Forest, Wis. 

'87. P. A. Hanson, Abram's Wis. Dr. Hanson w^as in the 
city recently. The friends of Dr. Hanson will be glad to hear 
that his health is fairly satisfactory. 

'87. C. A. Earle, Des Plaines, Ills. 

'87. A. R. Johnston, 4454 Cottage Grove Ave.. City. 

'88. J. A. L. Bradfield, La Crosse, Wis. 

'88. W. O. Anderson, New Castle, Pa. 

'88. D. T. Jones, Warsaw, Wis. 

'88. S. F. Shidler, Sheridan, Mo. 

'88. O. F. Pile, Memphis, Mo. 

'89. S. C. Stremmel, Wascamb, 111. 

'89. Frank Linden, 139^ Jacks. n Boulevard, City. 

'90. O. F. Prochaska, 1199 Broadway, Cleveland, Ohio. 

'90. A. G. Darling, 464 Warren Ave., City. 

'90. F. W. E. Henkle, 538 Ashland Boulevard, City. 

'90. F. J. Tower, Milwaukee, Wis. 

'9i. A. Colegrove, Taylorvill, 111. 
'91. S. S. Craig, East Troy, Wis. 




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Alnmni Notes. 318 

'91. Ottman Either Von Schallern, Ripon, Wis. 
, '91. R. H. Brown, 1217 Jackson Boulevard, City. 

'91. Alonzo L. Bushby, Pringher, Iowa. 

'92. Arthur J. Doty, Colman, S. Dakota. 

'92. A. G. Grubb, Mingo, Indiana. 

'93. Thomas Faith, 103 State St., City. 

'93. J. L. Stewart, Irene, So. Dakota. 

'93.. S. J. Boyd, 625 Washington Boulevard, Chicago, Prof. 
Therapeutics, 111. Medical College. 

'83. R. J. Morton, Green, Kas., has been taking a Post 
Graduate course in College of Physicians & Surgeons, and in 
Chicago Clinical School. 

'94. Dr. A. A. Foster of Marquette, Michigan, died on^Jhe 
6th inst. of Typhoid Fever. The Doctor was buried at Benton 
Harbor, Mich. Dr. Foster was house surgeon during his student 
days. Upon graduation he became interne at St. Mary's Hospi- 
tal, Marquette. For several years he has enjoyed one of the 
most lucrative practices in the Michigan peninsula. He was a 
charter member of the Nu Signu Nu fraternity. 

'88. Dr. Bradfield has recently sent the office some valuable 
reprints on affections of the eye. 

'93. Dr. A. M. Harvey, President of the Alumni association, 
was recently elected president of the Llth ward Republican Club. 

'95. Dr. Joseph Beck who has been in Prague for one year, 
has just gone to Paris for further study. 

'98. Dr. L. G. Witherspoon leaves for a year of European 
study on Jan. 1st. 

'96. Dr. John R. Hudson has recently written the secretary 
a very interesting letter from the Philipjjines. 



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LIBRARY NOTES. 
Grace W. Bryant, Librarian. 

So many new books have come in to the Library, that our 
•space this month will be devote! to a list of thera. 

The following articles from the pens of the Faculty have 
been noted in the journals. 

Dr. Geo. F. Butler. — The vegetable neurotics. Junr. A. M. A. 
Nov. 18, 1899, p. 1256-58. 

Dr. Wm. T. Eckley & Dr. C. S. Davison. — A unique case of 
double inguinal hernia. Gliic. Clinic. Nov. 1899, p. -1115. 

GIFT OF DR. HARPER. 

Ashton, W. E.— Essentials of obstetrics, 1890. 

Billingtou, G. E.— Diphtheria, 1889- 

Corning, J. L. — Headaches & neuralgia, 1890. 

Dexter, — Anatomy of the peritonaeum, 1892. 

Draper, J. C. — Medical chemistry, 1882. 

Fuchs, Ernest. — Opthalmology, 1892. 

Goodhart, J. S. — Diseases of children, 1885. 

Hardaway, W. A. — Vaccination, 1882. 

Hewson, A. — Earth as topical application in surgery, 1887 

Leffman, Henry. — Chemistry, 1890. 

JVIanson, O F. — Sulphate of quinine, 1882. 

Merrill, Albert.— Materia media, 1883. 

Morris, Henry. — Compend of gynaecology, 1891. 

Parreidt, Julius. — Compendium of dentistry, 1889. 

Stewart, F. E. — Compend of pharmacy, 1886. 

Van Harlingen, Arthur. — Diseases of the skin, 1889. 

Watson, U. A.— Cod liver oil, 1868. 

Wilson, Erasmus. — Diseases of the skin, 1868. 

Wolff, Lawrence. — Urinalysis, 1890. 

Holmes, T.— System of Surgery, 3v. 1881. 

physician's leisure library series 
Adams, U.— Electricity, 2v. 1891. 
Beard, G. M. — Nervous exhaustion, 1889. 



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X-Ray and Therapeutic -in-/' 1 

strument within the -reach 

of every doctor. ;^ ;/; \ » 



The Plexus. 320 

Dujardin, Beaumetz. — Diseases of the liver, 1888. 

Dujardin, Beaumetz. — Kidney diseases, 1888. 

Bosworth, P. H.— Takino^ cold, 1891. 

Bourneville & Bricon. — Hypodermic medication, 1890. 

Bulkley, D. L. — Acne & alopecia, 1892. 

Canfield, U. B. — Urinary analysis, 1891. 

Charcot, J. H. — Nervous system, 1888. 

Corning-, L. J. — Hysteria & epilepsy, 1888. 

Depres, Armand. — Fractures, 1890. 

Erlemmeyer, A. — Morphine habit, 1889. 

Gamaleia, N. — Bacterial poisons, 1898. 

Goelet, A. H. — Electro-therapeutics of gynaecology, 2v- 1892. 

Hamilton, A. M. ^Headaches, 1890. 

Hamilton, J. B. — Tumors, 1891. 

Hurd, E. P. — Insomnia & hypnotics, 1891. 

Hui-d, E. P.— Neuralgia, 1890. 

Jacobi, A. — Intestinal diseases of children, 2v. 1890. 

Leibermeister, K. — Infectious disease, 2 v. 1888. 

Loomis, Alfred. — Bright's disease, 1888. 

Love, I. N. — Diseases of children, 1891. 

Marcy, H. O. — Radical cure of hernia, 1889. 

Martin, Edward. — Sexual weakness & impotence, 1893. 

Robinson, F. B. — Intestinal surgery, 1891. 

Satterlee, Leroy. — Rheumatism & Gout, 1890. 

Shattuck, F. C. — Auscultation & percussion, 1890. 

Skene, J. A. C— Diseases of women, 1889. 

Stillman, C. F. — Treatment of hip-disease, 1891. 

Stockwell, A. C— Cholera, vl. 1893. 

Von Ziemssen, H.,— Tuberculosis, 1888, 

Willard & Adler.— Anesthetics, 1891. 

Wood. H. C— Nervous syphilis, 1889, 

Woodbury, Frank. — Dyspepsia, 1889. 

Wyman, H. C. — Diseases of bladder and prostate. 

Fltickiger, F. A.— Reactions, 1893. 

GIFT OF DOCTOR A. B. HALE. 

American Climates and Resorts, 1895. 

Barker, Fordyce. — Puevi^eral diseases. 1876. 

Clifford, W. K, — Seeing and thinking, 1879. 

Dudley, E. C. — Displacements of the uterus. 

Field, B. R.— Medical thoughts of Shakespeare, 1885. 




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Corner Madison Street and Ogden Avenue. 



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All the Latest Offerings 
for gentlemen's wear. Be 
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suit with us now. 

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Near Harrison st. 



PATENTS 



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OBTAINED. Send umdel, sketch or photo, with 
ili'siriiition for free report as to patentability. 48-PAGE 
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information. WRITE FOR COPT OF OUR SPECIAL 
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READ IT before applying for patent. Address : 

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ILLINOIS OOLLEGE OF PSYCHOLOGY 



AND SUGGESTIVE THERAPEUTiOS 



Incorporated. 



Establi.slied for the jjurpose of Clinical and Didactic instruction in tlie practice 
of suggestive medicine on .•strictly ethical lines, to physicians, advanced medical 
students and dentists ONLY. 

Patients are treated at the clinics for the relief of functional disorders, e. g. 
insomnia, habitual consti[)ation and enuresis, for neurosis, pain habits, hysterical 
contractures and paralysis, for drug habits, sexual perversions, etc. 

Students are given ample opportunity in these clinics to test their ability to in- 
duce psychic states and to make the appropriate suggestions. Diplomas are issued. 

For terms and full information address the Secretarv, 

RELIANCE BUILDING. 100 State Street, 

SUITE 1106, CHICAGO. ILLS 



Library K^otes. 

Gray, Asa. — Botany, 1864. 

Harley, John. — Old vegetable neurotics, 1869. 

Knapp, H. — Cocaine, 1885. 

Murchison, Chas.— Functional derangements of the liver, 1875. 

Rutherford, Wm. — Action of drugs on secretion of bile. 

Supplement of encyclopaedia Britannica, 4 v. 

Wild flowers of America. 

Wood's medical and surgical monographs, v. 3 no. 1 v. 4 no. 1. 

OTHER GIFTS. 

Amner, Surgical Assoc. — Transactions, v. 17, 1899. 

Berliner klinische wochenschrift. v. 25, 1888. Mrs. Windrow 
donor. 

Byford, W. H. — Reprints (Bound vol.) Dr. W. H. Byford, 
donor. 

Clarkson, Arthur. — Histology, 1896. E. G. Earle, donor. 

Denison, Charles,— Climates of the U. S. in colors, 1893. Dr. 
C. Denison. donor. 

Heineck, A. P.^ — General and local anaesthesia, 1900. Dr. A. 
P. Heineck, donor. 

U. S. Dispensatory.— Ed. 18, 1899. Dr. F. W. E. Henkel, 
donor. 

U. S. Marine Hospital Service. — Annual report of supervis- 
ing surgeon- general, 2 v. 1897, 98. 



HOLIDAY RATES. 



The Chicago, Milwaukee' & St. Paul Railway will sell 
excursion tickets to students and teachers going home for the 
holidays at rate of One and One- third Fare for the round- trip, on 
presentation of certificate from proper officer of the institution 
with which applicant is connected. Tickets to be good only on 
the closing day of the school and day after, but not earlier than 
December 23rd and for return passage to the day school re-opens, 
but in no case later than January 10th, 1900, Ticket Offices 
95 Adams Street and Union Passenger Station, Canal and Adams 
Streets. 



"TFIr» 



$1.00 •.-:•„ HUSTON BROS, 



AN A-1 



Hypodermic Syringe, 

WHY HAVE A POOR ONE? 



HUSTON BROS., 113 Adams St., Chicago, 

handle absolutelj- everything in the line of Instranienls. 
VERY SPECIAL PRICES AND TERMS TO STUDENTS. 

Drop in and get acquainted HUSTON BROS., 

R. BIRKELUNU is our CoIles:e Agent. II3 AdaiTlS Street, 



M. STEPNER, 

THE TAILO 



of 

350 Ogdeti Ave., 

HAS ALWAYS ON HAND 

A Full Line of 

Imported and Domestic Woolens 
with Special Prices for 

All gjirmeiits Well Fit and ^Mude. He also 
Cleans. Dyesand Kepairs at very low prices. 
Satisfaction Uuaranteed. 



Johston's Cafe, 

835 W, HAR!!ISON STREET, 

Having purchased and remodeled 
my new location I solicit the patronage 
of both old and new customers. 

Chas. E. Johnston. 

Proprietor. 

Commutation Tickets, $3 50 
For $3.00. 



GLASGOW WOOLEN MILLS CO, 



The World's Largest and Orea est Tailors. 

Some people have discovered that they have been paying double what they can 
pecur J tailor-made garm3ncs fof. Others will neve.- wakj up to this fact,, because 
they don't take the time t) investigate, firing us a sample of the goods that your 
tailor chacges you $30 for and we will duplicate it for you for 

No More -$i5.oo~ No Less. 

Your choice of over two thousand fabrics. "We have no agents or middlemen to 
divide with. We make no wild claims. You get the benefit of our being mill owners. 
Last season we made to order in our Chicago store alone, upward of 30.000 suits and 
overcoats, and in our 56 stores in Europe and America we sold over 3,000 garments 
daily. 

For the benefit of out-of-town and city working people during the day, we keep 
open all evening. When in the city. call and look through our line of goods and oom- 
I^are them before purchasing elsewhere. 

Complete illustrated instructions for taking measures on self measure blanks, 
flna line of samples and cuts of all styles, mailed on receipt of ten cents to cover cost 
anp postage. Chicago headquarters, 

191-193 State Street, Palmer House Block. 



ihe PUxus. 822 

SENIOR NOTES. 

Hurst evidently wasn't feeling well at time of roll call. 
"Squeezing as a fac'.or in tracheal fractures."' For informa- 
tion, see Miss Morgan. 

Scarlet fever has neither added to, nor detracted from, our 
chairman's good looks. Any how, every one is glad to see Hum- 
mel back again. 

It w^as rather inconsiderate of Dr. Christopher to allure so 
many of the class into getting vaccinated so near the time they 
expect to see their best girls. Bloch boasts that he was too wary 
to be caught. 

See Birkelund, Hurst, et al for surgical supplies, drugs and 
taffy. 

Tickets are now on sale for a special attraction Pt Tattersall's 
in the near future. A ten round bout between Parsons and Sas- 
saman will be the leading feature of the evening. At present 
bets are running 5 to 4 in favor of Sassaman and some difficulty 
in placing them even at these odds 

According to "Shep" the wear and tear on the planes of the 
pelvis is something remarkable. 

Why doesn't Just wear the tile to school? 

Our columns are too crowded this month to insert an adver- 
tisement for a lost dictionary. There is one lost, strayed, or per- 
haps stolen, any how. 

Since the mirror has not appeared for several clays, we pre- 
sume that in accordance with Dr. Steele's suggestion, it is being 
preserved for the "Illumination of somebody's record before the 
Angel Gabriel." 

We believe the senior class has just cause for suit and dam- 
ages from "Rush" for alienating the affections of one of our girls. 
Sadie avers ardent admiration for our neighbors and we fear it's 
all too true." Possibly "Distance lends enchantment." 

The smiling countenance of our old friend Gaul occasionally 
appears at the top of the amphitheater, and is always the signal 
for a muffled demonstration in appreciation of his kindly encour- 
agement. 

Since Dr. King's allusion to poetry, the following original 
productions have been handed us for publication: 



PROSPECTUS OF THE COT.LEGE. 

The eighteenth annual course of instruction will begin the third Tues- 
day in September. 1899. and will continue seven months, closing the third. 
Wednesday in April, 1900, with the public commencement exercises. 

In addition to the regular Winter session the College offers a Spring- 
session of two and a half months. The Spring ses-i<.n of 1900 will begin 
April 20, 1900, and end June 30, 1900. During the course about one-third of 
the "Winter session is gone over and credits are given for the work done. 

REQUIREMENTS FOR ADMISSION. 

Every candidate for admission is required to present credentials as 
follows : 

1. A certificate of good moral character from two reputable physicians, 

2. A diploma from a rocos'iized col e?e. academy, or liigh scliool. Students una- 
ble to meet tliis requirem'»nt are admitted on passin,' a satisfactory examiaatioi in. 
the following subjects : 

(a) Kiiglish : The writin'j of an essiy of at least two hundred words upon a se- 
lected subject. Goldsmith's "-Vicar uf Wakefield" will f.,inish the basis of the exami- 
nation in English for tliis year. 

(6) Physics: The principles of mechanics and hydraulics. Descbanel's Natural 
Philosophy, Fart I, is recommended in preparation. 

(c) Mathematics: Ai ithmetic and silgebra; plane geometry, as given in Wells' 
or Wentworth's Geometry. 

id) Latin grammar and an examination in translating Latin into English fronn 
"Caes;i.r's C'ommentarie.-," represent! ii'_' at least two years' siiuly of Latin in an accred- 
ited high school. One year will be allowed in which lu leniedy defects in Latin. 

Tiie fntrtince examination will be condui-te I in writing, under the dire lion of 
the President oi the University, by a comm ttee outride tiif* Faculty of tlie IMedicai 
School, and will be held at the College at 1) a. m., on the Mondays preceding the open- 
ing of the Winter and Spring terms. iJiploiiias and other credentials shoulu ie pre- 
sented at that time. 

PLAN OP INSTRUCTION. 

The instruction is arranged in four distinct annual courses. The col- 
legiate year consists of a Winter term of seven months, and a Spring term 
of two and a half months. Attendance upon the Spring term is optional. 

EQUIPMENT. 

The College building is a six story structure on the corner of two wide streets, 
with an open space around it on all sides. It is heated by steam and provided with all 
modern conveniences. It contains three well-lighted and well-ventilated amphi- 
theatres, the rmallest of which seats two hundred students. 

Adjacent to the College building on the west is the Laboratory, a structure re- 
cently built by the College and fully equipped for all kinds of laboratory work. The 
Laborjitories contained therein are among the lariiest and mostcomplete possessed by 
any medical college in the United State-. They occupy loui- floors, and each will ac- 
commodate 130 students at a time. They are provided with desks and lockers for each 
student. Adjoining the laboratories are preparation rooms for the use of demonstra- 
tors and professors. There is also a bone rontn to which students have free access for 
the study of osteology. In the department of pathology the ])aih()logical collections 
furnish ample materials for tiie macroscopical as well as tlu'microst-opical study of dis- 
eased tissues. The storerooms are connected with all the laboratories by means of an 
elevator. In the instrument room are thirty one first-class l.ei'z microscopes, and 
forty-three Bausch & Lomb microscopes of continental patterns, besides foity micro- 
scopes of various other manufactuiers, all for the use of students. The College has 
also sixteen Bausch & Lomb microtomes, besides microtomes of large size and special 
construction for particular kinds of work. 

Clinical Facilities. The Bispensary occupies 1 he first floor and a portion of 
the second floor of the main building. Connected with the reception room are fourteen 
lor clinical instruction. During the past five years there have been treated in these 
rooms an average of 30,000 patients each year. 

Obstetrics. In this department the student is taught practical obstetrics by- 
means of demonstration (women In labor) before the class, and by attendance upon 
cases of confinement at the homes of the patients and in the West Side Hospital. ^• 

The CoUego has also recently established an obstetrical clinic for the purpose of 
giving students practical bedside experience in obstetrics. This clinic issituated with- 
in a convenient distance of the College, but in one of the most densely populated parts 
of Chicago, and the amount of fibstetrical material available for instruction is equal to 
sll demands upon it. A physician and nurses are In attendance day and night, and, 
under their direction, senior students will be given the care of obstetrical cases. lit 



Senior Aotes. 3-3 

"Spring" ''.'.'.■ Mrs. McCaffry.'' 

"Boolging" .... ..W. D. Milroy. 

"Rest Sweet Rest" A. J. Norseman. 

' 'The Effusions of a Love Sick Soul" . . McCormick and-Moradian. 

"Hiawatha" ..W. N. Moffet. 

We regret to announce that all of the above were denied publi- 
cation on account of their sentimental tendencies. • ; 

Mitchell sustained a severe rupture of the external investment 
of his left lower extremity during the gentle efforts of about 
fifteen of his admirers to assist him to a higher, seat, The 
tenderest sympathies of the entire class are at his disposal in his 
misfortune. We all know how it goes. ' , 

The dropping of the D. J.'s during the Cesaerean section re- 
sembled somewhat the falling of hickory nuts followtng a frost. 



JUNIOR NOTES. 

How is this for a compliment? Dr. Brown says the junior 
class is the best and most orderly class that he has had the pleas-' 
ure of meeting for a number of years. 

The announcement of Mr. Rhodes' election to the staff of the 
lUini should read Ilio instead. 

Your class editor wishes to apologize for any deficiency iu 
the notes for this number of the Plexus, as he has had only about 
tea days in which to gather in the articles. He also requests that 
the members of class give him any articles of news which would 
be of interest to us. / 

Miss Poison chuckled and 

Miss Willing did the same — 
As Severson and Cupler ;. _ 

To the C. A. came. 
The reason you may guess 
And will certainly say yes 

They were out the night before. 

We have another operation for the barber, that is Willie Sco- 
field's hair lip. However you may not have noticed it as it is 
only vitible when the electric lights are turned on. 

All of the members of the junior class are now wondering 



this way students will be able to set ample practical experience in obstetrics Thf ar- 
rangements are such iliat attendance upon cases w.ii oe accotnp.iun rl bj ;is little oss 
of time to the student as possiule, and this work, therefore, will not undmy iiitei fere 
with other college duties. 

Hospitals. Members of the faculty and other friends of the College have re- 
cently purcliased tiie adjoininij building of the Post-Uradj-ue School. his has i.een 
convt rted into a private hospital of one liuiiured and twenty-tive i.eds. under iht • anie 
of Ihi' West Side Hospital A cor ridur connects it with the i ollejjt ampitheater. One 
entire tloor in this hospital is set aside as a wara lor the use oi the < oilege foi clinical 
instruction. 

Directly opposite the College is ihe Cook County Hospital, This institnlion is the 
only free hospital in Chicago. It contains eight hundred patients, and tluih -upplies a 
quantity and variety of material which no private institU' ion ca'. command In ihe 
ampitheater of this hospital is conducted much of the clinical instruction of the 
College. 

The County Morgue is located In the hospital grounds, and daily post-mortems 
are held by the pathologists of the hospital. To these our students aie admitted, and 
tney are required to attend a certain number of these post-mortems. 

Medical appointments in this institution are made by the County Commissioners 
each year. Tiir internes, twelve m number, arc selected each Spring by a competitive 
examination, which usually lasts thiec day~. Only graduates of medical colleges of 
Cook County are eli-ible for these examinations The internes serve eijihteon mont'is, 
and receive their board and lau-idry and i.ave rooms in the hospital They do a large 
amount of surgical, medical and obstetrical work. These position^ are justly looked 
upon as the irreatest medical prizes the city affords to young physicians. 

The students of this ' oilege are required to attend the clinics ot the Cook County 
Hospi'^al durin^^ their Junior and Senior years The ticuets cost $.t 00 a year, and ;ire 
'or sale on the first day of October at the olBce of the VVarden. They admit the houlers 
to all clinics and lUtopsies and to all public operations and lectures in the hospital 
grounds during the year. 

The Illinois Charitable ^ye and Ear Infirmary furnishes a laree clinic, to which 
our students are admii ted without fee. Four of the attending staff are professors in 
this College, and use the material for illustmting their courses. The Woman's i ospi- 
tal. the West Side Hospital, the Chicago Hospita', and St. Elizabeth s Hospital, give, 
without fee, an opportunity for clinical instruction, especially in Gynecology aud 
Abdominal Surgery. 

METHODS OF INSTRUCTION. 

Instruction is g^iven by mf-ans of lectures and recitations, demonstra- 
tions and laboratory work, and ambulatory and hospital clinics. 'I'hi- lime 
of the student is about equally divided between laboratory work and cl nics 
on th<- one hand, and lectures and recitations on the other. The work of 
each year is complete in itsjlf, and credits are given as the work is 
accomplished. 

la each lef^ture hour the subject of the preceding lectu'-e is reviewed 
by a quiz, and defects in the understctnding of the subject are thus easily 
detecteQ. 

Laboratory work is done from the beginning by the student. Materials 
are furnished him at cost, and he retains his preparations and drawings. 
Laboratory work is so arranged as to maintain what is thought to be the 
bjst relation betwe -n the lectures and clinical studies. 

In thes clinical work, methods both of inv*^stigation and of reasoning 
are cirefully and systematically taught. The diagnosis. pr< gnosis and in- 
dications for treatment receive no less a share of attention than the meth- 
ods of treatment and the technique of operat ve pi'ocedures. The clinics, 
as Well as the post mortem room, furnish material for pathological, chem- 
ical and bacteriological study, an 1 thus bring all departments of instruc- 
tion in close relati'in in the min 1 of the student. 

Attendance upon the cl'nics is required the same as upon lectures, and 
students are graded upon and given credit for their work in the clinical 
courses just a- they are for their work in the didactic and laboratory 
courses. During the Spring term the dispensary clinics are thrown open 
to students of all clas.ses. During the winter, assignments are made of 
dispensary rooms to groups of students selected from the Junior and Senior 
classes in rotation. Attendance upon these clinics is required. 

ADVANCED STANDING. 

Student,'* who have completed a "medical preparatory course, equiva- 
lent to that given by the University of Illinois, and graduates of reputab e 
schools of pharmacy, veterinary science, or dental surgery, may enter the 



Junior Yo'"S. -^-4 

what Santa CImus has in store for them and belo^s? is a parti il list 
to be sent to his excellency through the Plexus; 

OUR CHIilhTMAS WISH. 

Teddy wants a rocking horse 

Aiid Davy wants a pony 
Miss Wallen i > qu e hippy • 

Now, living in matrimony. 
Big Joe wants a bran new name 

That every one can say— 
And Miss Cater wants to wear — , 

But then, she is not built that way. 
Wesley wants a pair of skates 

With nickel plate all over; 
John M. thinks with only one 

He'd feel as though in clover. 
Willie Osborn far away 

Would be content on Xmas day; 

If he could but just partake 

Of a pie, like mother used to make. 

C. M. N. 

Ling will do a month's washing as a reward to the person 1 <»1 ' - 
ing him who it was that soaked him in the eye. Here isach nee 
for Cory to discard his sweater. 

We should like very much to see Miss Cater and Frank put 
on the gloves and have it out. 

Ringold pays pretty good attention since Dr. Burr cansrht 
him in the act. 

We regret to annonnce the death of Mrs. E. E. Rouse, the 
wile of one of our classmates. 

Pres. Howard was requested by the members of class to write 
Mr. Rouse a letter expressing the sorrow of the class at his be- 
reavement. 

SOPHOMORE NOTES. 

A STORY WITH A MORAL 

(True). 

A Sophomore may know more anatomy than a Freshman. 

He may even read a Materia Medica and know that quinine is a 

bitter drug, and given in doses of 1 to 60 grs. If he is a studious 

Sophomore he may even list<-n to ectures on Therapeutics and 



Sophomore Class and complete their studies upon three years' attendance, 
provided they fulfill all other requirements for admission and gradual ion, 

w Students who present evidence of having attended one or moi-e years at-, 
other medicai institutions in affiliation with the Association of American 
Medical Colleges, and in good standing with the Illino s State Board of 
Health, may be admitted to advanced standing without examination. 

EXAMINATIONS. 

Examinations for advanced standing are held the week before the 
Christmas holidays. ' ,'• . 

Students are examined and graded daily, and at the end of the sessinia 
iht^y are passed or rejected upon these class records: the provision is mad- . 
hcuever, that a student who fails to obtain a passing grade in the course of 
the s- !-sion may, at the discretion of the teacher, be given a final axamina- 
tion and be graded thereupon. 

CERTIFICATES OF ATTENDANCE. 

At the end of the Winter term a certificate of attendance will be issued, 
showing the credits earned. 

LIBRARY. 

The College has a reference library of several thonsand volumes for 
the use of the students, in charge of a trained librarian, 

FEES AND EXPENSES. 

The fees are payable in advance. Tlie Irustees reserve the riqht to chmif e 
them at any time through publication in the annual announcement, 

FEES FOR THE WINTER TERM. 

Matriculation fee, each year of attendance $ 5 OO 

(ieneral ticket, each year of attendance i .,; lOS to 

Laboratory expense ticket* , ...,.,. 29 OW 

FEES FOR THE SPRING TERM. 

MatriculHtion fee, good for the entire year '. ,,..S 5 CO 

General ticket 2iU0 

Labi iraiory expense ticket .- 10 im 

'Ihere are vo fees for special courses or quizzes, and no fxaminatiov or ijrac^ 
uafian fees. No instructor, dispensary physician or professor is allowed, 
under any circumstances whatever, to receive a fee for instruction. 

BOARD AND LODGING. 

The expense of living in Chicago is less than in most other large cities. 
The entire expenses for the Winter session are as follows : 

Miitri ulation fee $ ii 00 to $ 5 00 

•iiii'ion 105 00 " 105(i> 

Lai;:;drv 10 00 '* 15 dO 

Books and instruments....; 15 00 '• 20 00 

Inciil. iiials 30 00 " 6i' "0 

Board and room 105 00 " HO lO 

Tntsl 1270 00 $Uf^ 00 

The entire expenses of the majority of students do not average above 
$:ioo.oo. 

Address all correspondence to 

Dr. Wm. Allen Pusey, Secretary, 

103 State Street, Chicago. 



*Against tills depositof S25.00 will be char<;ed up all laboratory material, disse -t- 
iutr material, and all breakage. The balance will be returned at the end of the school 
year. 



Tha ricxiis. 325 

Preventive Medicine, and this is all as it should be, but at most 
it is little and in projoortion as it is meager, is its danger, for 
even the poet who knew little or nothing of medicine said so 
glibly: "A little learning is a dangerous thing, etc," and so it 
happened that Soph. G. L. came to grief. Now G. being of a 
living turn, promptly fell in love, and after many machinations 
and intrigues, such as lovers often indulge in, he received per- 
mission to call on a certain evening. That afternoon G's room- 
mate called "present" for him, while he remained in his room 
commencing ardent preparations for the evening. He knew his 
chances were but one out of many, and on this meeting depended 
his entire future happiness. "I must shine, I must shine," was 
the refrain running through his mind while he brushed and 
scrubbed and combed. He knew that Sh-lt-n, Gu-i k and 
Kt-t — m-n were all in a close race for the same girl; now if he 
could but with one fell, swoop, banish forever the little chemist 
and his pals from the heart of the maiden, then would he rejoice 
and be exceeding glad. "For what profit is it to know chemistry 
if you lose the idol of your existence," thought the youthful G. 
So promptly at 7:45 he was in the young woman's presence; how 
he managed it he never knew, but being here, it was his duty to 
shine, and yet every available topic of conversation had either 
vanished or seemed too tame. The truth to teell, G. was ill at 
ease. A city belle seemed so different from the rollicking girls 
he had known in Creston. But the young lady, having had 
numerous such experiences came to his rescue, for seeing that 
he was guileless as a lamb gamboling in his father's barn yard 
and free from conceit, she immediately commenced to make him 
comfortable in a way as only such girls can. But some how G. 
was distrait and conversed in monosyllables until the tactful 
girl mentioned college, and than G.'s sails took the 
breeze, his legs untwisted the twentieth time, he forgot his 
hands and his tongue loosened. He told about the dissecting 
room with the ardor of a Freshman, until she implored him to 
stop, (the identical thing had happened when S., C. and K. had 
called). He talked about medicines and cures for this and that, 
when suddenly she laughingly asked him to try his medicines on 
a small eruption on the tip of her pretty chin. "I will shine' 
thought G. "Here is my chance to nail Sh-lt-n, et al; what do 
I care about carboxyl and keytones or isobutyl-carbinol and the 
rest of those things Sh-lton is so full of," flashed through his 




FALL EFFECTS. 

New Shapes. New Shades. New 
Prices for Hats!,_^^^ ^ •} 

Buy Direct from the Manufacturer 
and Save the Middleman's Profits. 

ALL STYLES AND SIZES MADE TO ORDER WITHOUT AD- 
DITIONAL COST. 

Your old hat remodeled into the Latest Shape. Satisfaction Guaranteed. 

POWERS, Manufacturer of Hats. 437 OGDEN AVE. 



i^E UMIVERSITY OF ILLinOIS 

ANDREW SLOAN DRAPER, LL. D., President. 



CIFTEEN Building-s, Two Hundred §i» j 1 RRARIES, Astronomical Observa- 

' and Ten Instructors. Three Hundred ^ ^ tory, Laboratories, Shops, Farms; 

and .Fifty Different Courses of Instr-uc- %i malving ont- of the very best equipments 

tion, Sixteen Hundred Students. .". .•. |» in the United States. .•- .". .*. .'. .• 

COLLEGES OF Literature and Arts, Agriculture, Science, Engineering. 
SCHOOLS OF Music, Art and Design, nilitary Science. 

School of Pharmacy (Chicago College of Pharmacy), 465-67 State St, Chicag-o. 

School of Medicine (College of Physicians and Surgeons), 813 W. Harrison St., 

Chicago. 

School of Law at the University. State Library School at the University. 

GRADUATE SCHOOL. 

Architecture, Civil Engineering, Electrical Engineering, Mechanical Engineering 

Sanitary Engineering. 

State Laboratory of Natural History. 
United States Agricultural Experiment Station. 

Military Band, Orchestra, Glee Cluh, Ladies' Glee Club, Mandolin and Guitar Club, 

Male Quartette, etc. 

One hundred' and sixteen free scholarships. 

MuJii Attention piii to \thliti;i. ^ IVl ;n an J Wjn:ii AJmitted on Equal Terms. % The Best 

Preparatory Medical Course in tlie United States. ^ Biological Experiment Station 

on the Illinois River. %, Pedagogical Department of Harked Excellence. 

The State of Illinois is behind this University, and will allow it to be second to none. Students 
are received from Approved High Schools on their Diplomas. 

For catalogues or detailed information, write W. L. PILLSBURY, Registrar. 

Two Postoffices. Address either Champaign, or Urbana, Til 



/Sophomore Kates. 326 

mind. "I'll teach him that it is medicine and not chemistry that 
wins its way to a girl's heart." So he promised to bring an 
efficient remedy the very next evening. What a grand covp de 
etet. But G. didn't know any thing about this particular pimple 
or in fact any other; it is doubtful whether he saw it at all. 
Had he been older and a graduate, he would have brought a 
little sugar and water, the pimple would run its course, and G. 
would forever enshrine himself in the very heart of the damsel. 
But G. was as yet an honest boy and on his way home the word 
urticaria came to his mind. "That's a good clew to begin with," 
thought he, and he read diligently most of the night and all 
next morning and even got Sh-lt-n to call "present" while he 
prepared his medicine. That evening he again found himself 
with the young lady and hardly had the formal greetings been 
said when G. in his great eagerness blurted out, "Oh, Miss S., I 
have something fine for your piles. "" How he got "hives" and 
"piles" confused or whether he knew a difference existed, will 
never be known, but the sad fact remains, he said "piles." For 
a moment the damsel was dumb-founded, but only a moment. 

"Why, Mr. L how dare you? You horrid thing, why — I — I 

never had !eave me at once.'' And with this she fled from the 

room. But she was not the only one dumb-founded, poor G's 
jaw dropped and made several ineffectual vibratory movements 
to answer but none came. His eyes seemed ready to spring 
from their orbits, his knees shook and with a tremendous effort 
he cleared the room, leaving hat and cane behind. His transit 
down two flights of stairs was comet-like. He reached his room 
and there the full extent of his awful blunder struck him with 
all its horrors. So great was his chagrin, that he sat down and 
cried, for now he knew that that horrid Sh-lt-n would be on the 
scene again, and that his own sun had set, and so it had, but no 
amount of money or persuasion can ever get G. within five 
blocks of that house again. 

Moral. — A Sophomore's knowledge is dangerous. 



FRESHMAN NOTES. 
Reports are out that L. B. Donkle had to "write home for 
money" after the Chicago— Wisconsin game of foot ball. How is 
it "Donk"? 

Biedenkopf has lost his hirsute appendages. We have been 







■ ^^^-^^Si\ lii—-^-- "- 



gpaldingg (Irade mark) foot g 

SUPPLIES FOR 1899. 

The Spalding Official Intercollegiate Foot Ball lo 
ISfiQ is the mt St perfect foot ball ever made and is used 
exclusively by all the principal teams. 

Every requisite for the game, including Moleskin 
and Canvas J-ickets and Pants, Shoes, shin Guards, 
Elastic Belts, \Vrist and Ankle Supports, Shoulder, 
Elbow and Knee Bandages, Nose Guards, Head Harness 
.Jerseys and Sweaters in college colors, stripes, etc. Man- 
ageis should write for prices and samples before order- 
ing elsewhere. 

Spalding's Official Foot Ball Guide. Edited by Wal- 
(1 ted Camp. IsOV) rules; records; photographs of leading 
teams; 240 pages, postpaid, IOC. 

Handsomely Illustrated Catalogueof all 
Sports IVlailfd Free 

. A. G. SPALDING & BROS, '''"''t^^'' 




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OTHER TRAINS 8.30 a.m., 10.30 f- M. 

Ticket Office, 95 Adams Street. 



The Salus Aseptic Cotton Applicator. 




Patented March i 



BACTERIOLOGIS FS have demonstrated the importance of u~ing thorougUly sterilized and 
aseptic instruments in ooeratina. It is known thai much suffering has been caused by tlie use of 
infected instruments. Perhaps the greatest, transmitter of disease has been the filthy probang 
witli its bnstie, sponge, and camel's liair ends. The 11 ibllity of transmitting contasioii by this me- 
dium is overcome with the KAF.US ASKl^TIU COrrO.N AP.-L[C \T<JK, which, owing to its 
peculiar construction (l)eing made of Hard Rubber), can be sterilized after usinsr. simply by plac- 
ing in hot water for a few minutes. It has proven to be the most satisfactory instrument with 
which to apply, ihrougii the agen -y of absDrbent cotton, medicated solutions to the throat, nose, 
ear, vagina, and recturn Pliability is a 'zreat foature in is favor. 

Special offer to Physicians-A Silus Aseptic Cotton Applica.tor mailed postp lid upon 
eceipt of fifty cents in stamps. 

THE SALUS ASEPTIC INSTRUMENT CO.. Prop's. St. Lojls. Mo. 

Wholesale Agents— ;\Iey<;r Bros. Drug Co., St. Jiouis. A. S. Moe Co., St. Louis. 

Geo. Tiemann & Co.. New York City. RIcrr son-Plummer & Co., Chicago, 



The Plexus. 327 

^wondering if it were done so that he might better carry on his 
study of Ornithology. At present he seems greatly interested in 
the "Martin." 

Instructor — Is there something burning up there, Mr. Shoop? 

Mr. Shoop — ^Yes Sir,matches(?). 

Our class president, W. T. Barnum, was called to his home in 
Michigan recently, on account of the death of his wife's father. 

L. M. Power had a collision with a projecting part of the 
building recently and as a result carries a black eye. 

3Iiss Dunn enjoyed a visit recently from her sister. 

Neighbor Sure would make a good deacon, he is a good sleep- 
er in lectures. Come, now, "Deacon" Sure, wake up. 



NEWS ITEMS. 



Is you subscription dueV If so, will you not kindly send it in? 
The subscription is payable in advance. 

All students should bear in mind that they can get one and a 
third fare for round trip Xmas. vacation, on all roads in the 
Western Association. You can secure the j^roper certificates at 
the office, from Supt. Verry. 

We are sorry to announce that E. E. Rouse, of the senior 
class, was deeply afflicted by the death of his wife Tuesday, Dec. 
5th, at their home in Benton Harbor, Mich The Pl,exus and his 
many friends extend their most heartfelt sympathy. 

A new fraternity has been organized in the P. & S. college, 
the Alpha Kappa Kappa, Eta Chapter. It was instituted by Dr. 
G-eo. Cook of Alpha Chapter, Dartmouth college. 

The Alpha Kappa Kappa is a well established eastern f rater 
nity, but only during the last two years it has been instituting 
chapters in the west. One at Leland Stanford University, one at 
the University of Minn., and^the one here are the only chapters 
in the west at present, although several of the leading colleges 
have made application. 

Friday night they held their installation banquet at the 
Great Northern. Profs. Cook, Quine, Newman, Evans and Wig- 
gin responded to toasts. "Mr. C. N. Heath responded to the toast 
"Nu Sigma," and Mr. M. J. Seifert to "Good Night." 

The following is the program of the entertainment given by 



Volume One— Ready 5ept. 1899. 
The Internaiional Text Book of Surgery. 

In Two Volumes. Edited by J. Collins Warren, M. D., LL. D. '■ 
Boston, and A. Pearce Gould, M. S., F. E. C. S. Eng., London,. 
England. Volume One, 8vo. (7x10 inches), about 950 pages, with 40O 
beautiful illustrations in the text and 9 full page colored plates. 



Sold only by Subscription. 



PRICE, $5.00. 

W. T. KEENER, Medical Bookseller. 



Sole Agent, 52 Randolph St., CHICAGO 
Chicago Depot for W. B. Saunders' Publications. 




HBBARD'S 
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Sttidenls' Patronage Solicited. 

Offif^e. Winchester and Ogden vVvenues^ 
Tel W. 2S3. STORAGE. 



SEELEY AVENUE LIVERY, 

C. r. TRAPP, Proprietor. 
Boarding, Sale Stable and Coupe Line. 

Single Broughams ^1.00 per hour. 
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Telephone West 54 



Prices as rifrht ns <iiir n'o-s. 



Cor. Seeley Ave. 

Call me up. 



Look Up Appleton's Hethod 

of supplying Subscription Books to Student's. The 
only easy way of obtaining Standard Medical Books. 



^ Osier's Practice 

<t Holt, On Diseases of Children. 

J Tillman's Surgery. (aVols.) 

^ Kelly's Gynecology, (2 Vols.) 



J 
J 
J 
J 



B. C. GROUT, 

Gen'l Agent, 1004 W. ADAMS ST^ 



^ Puchs, On the Eye. 

> Ewald's liiseasts of the Stomach. 

/ And many other well known 

^ and standard text-books. 



For Information See 
G. G. DOWDALL 



N(ics Items. 228 

the Nu Sigma Phi Fraternity of the College of Physicians and 
Surgeons, at the Auditorium Recital Hall, on Wednesday, De- 
cember 6th, 1899, at 8 p. m. The members of the committee hav- 
ing charge of the entertainment were Dr. S. A. Yingst, Mrs. E. 
E. Luesman, Elizabeth M. Heelan. 
Program — First Part. 

Piano — (a) The Butterflies Lavallee 

(b) Berceuse Chopin 

Master Earl Blair. 

Duett — Let Music and Song Bishoff 

Mrs. M. D. Cropper. Hattie Marie Cropper. 

Bass Solo — (r/) A.sleep on the Deep Petrie 

(b) Slumber Romance Gounod 

Mr. W. H. Ward. 

Soprano Solo — (a) Night Time Van de Water 

(b) The Seasons Cowen 

Miss Hattie Marie Cropper. 

Violin Solo — II Trovatore Verdi 

Mr. Chas. Sherman. 

Aria — Roberto o tu che adoro Meyerbeer 

Mrs. M. D. Cropper. 

intermission. 
Second Part. 

Piano — March Winds McDowell 

Master Earl Blair. 

Duett— Under the Roses Werner 

Hattie Marie Cropper. Mr. W. H. Ward. 

Solo — Basso — («) The Miner Sutton 

(6) Les Cloches de Corneville (Rondeau Valse) .... 
Mr. L. Van Linghem. 

Soprano Solo — Summer Cham enade 

Miss Hattie Marie Cropper. 

Duett- — A night in Naples Brignoli 

Hattie Marie Cropper and Gustave Liebtch. 

Quartette — In this hour of softened splendor Pensuti 

Mrs. M. D. Cropper. Mr. Gustave Liebicp. 

Hattie Marie Cropper. Mr. W. H. Ward. 

-Comedy — A Masked Battery . . 

Mr. Edward OwiNGS ToA^NE. , 



..MEDICAL BOOKS... 

Headquarters for all the books 
used in the P. & S. College. 

LATKST EDITIONS. LOWKST PRICKS.^ 

Drafts Cashed for our Customers. 

EDWARD SPEAKMAN, 

One block North of College. S- E- Cor. Congress and Honore Sts* 



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The absorbent pad absorbs the mois-ture during- heat exposure, -which admits o 
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The heat is perfectly distributed and regulated with an Aluminum Hot Air Chamber,. 
flexible, especially adapted to fit any part of the body.either sitting or reclining-. The 
burner ^either gas or alcohol) it enclosed within heater. Patient always has control 
of regulated heat up to 400 degrees. The whole outfit weighs about 5 lbs., packed 
in convenient case for carrying. A wide departure from the cumbersome, exjenaiTe 
machines upon the marke". 

(ZT One test on a single case of Rheumatism, Neuralgia, Inflammation, Congestion, 
Spinal or Joint trouble vill convince any physician it is a necessary adjunct to iiis- 
practice. If not, return it within thirty days in good condition, and money refimded-. 

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We carry the largest line of medical publications in the city- 
Latest editions guaranteed. Also a large line of 
second-hand medical books. 



230 The Plexus. 

nervous exhaustion, so called, but merely to remove patients from 
surroundings that interfere with a normal way of living, and put 
them under influences that will restore them to normal conditions. 
Patients who are very weak and depressed, or have gotten into a 
fixed habit of being sick, must be put to bed and dieted, massaged 
etc. in order to begin at the beginning of a new and normal life— 
not for the purpose of taking an ahnonnal anionnt of rest. Many 
who are getting into the neurasthenic state from an improper 
mode of living may be helped by intelligent directions from the 
physicians and the same end be attained without prolonged rest, 
isolation or forced feeding. 

In ordinary practice in small towns the following simple plan 
will usually bring pronounced cases of neurasthenia in six weeks 
to a condition of good physical training with ability to walk four 
or five miles a day, instead of merely being ready to commence 
vigorous exercise at that time, as is the case with the orthodox 
rest cure. 

Supposing the patient to be a woman, 'the first thing for the 
physician to do for her is to rent a room in a neighboring town 
away from friends, and where he can make a daily call. He 
should also put her in charge of a nurse or reliable woman who 
will follow directions, and who can give her systematic rubbing 
and kneading of the general muscular system. The following is 
a brief statement of the treatment. 

1. The patient is kept in bed from three days to one week, 
according to the amount of exhaustion, but allowed to move about 
freely in bed, and sit up in bed when she eats. 

^. While the patient is in bed. and until she can take plenty 
of exercise, the want of exercise should be supplied by massage 
or systematic rubbing and general faradization. One is given in 
the morning and the other in the afternoon, or one may some- 
times be given at bedtime if it tends to put the patient to sleep. 
3. The diet during the first two or three days should consist 
of from three to four ounces of milk every three hours, either 
hot, cold, with lime water, or made into a soup or thin gruel. 
This restriction gives the disordered stomach a rest and puts it 
in a condition to assume normal functions. During the remain- 
der of the week a glass of warm milk is taken every three hours, 
and i^lenty of thinly cut dried toast or stale bread lightly buttered, 
with fruit (such as orange, apple or apple sauce) is allowed three 
times daily with each alternate glass of milk. During the second 



Care Without R^st. 231 

week an egg, or a small piece of broiled beef or mutton is added 
to each morning and noon meal and a small dish of light cereal is 
given for supper. During the third week light vegetables, fresh 
fish and fowl, and graham or entire wheat bread are added, and 
perhaps a small quantity of cereal for breakfast. No desserts, 
preserves or sweets of any kind are allowed while under treat- 
ment, nor subsequently. After the first week the glass of milk~ 
is given between the meals (which are six hours apart), at bed- 
time, and early in the morning if the patient awakes early. Thus 
it will be seen that she is somewhat restricted as to the amount 
of food, excepting the milk and bread, of which she can have all 
she desires. Many patients with indigestion think that they can- 
not take milk, but if it is scalded or given as oyster soup or milk 
gruel it will agree with them. 

If the patient is fleshy and not decidedly anemic, she is kept 
niainly on skimmed milk for nearly a week. If, however, she is 
greatly emaciated and exhausted from malnutrition, the solid 
foods are commenced after two days and are given more abund- 
andantly, for the starved tissues will take up the nourishment 
abundantly and rapidly. 

4. Medicines are seldom needed unless it be perhaps a hyp- 
notic the first night or two, and mild laxatives during the first 
week. The restricted diet of the first week makes them sleep 
well, and the increased diet with abdominal massage usually reg- 
ulates the stools after that. No anodynes are given. Electricity 
and massage take their place. 

5. This brings us to the most important part of the treat- 
ment viz: exercise. The exhausted and anemic condition of these 
patients comes usually less from excessive wear than from physical 
inaction, with its accompanying dyspepsia, sleeplessness and 
malnutrition. If the patient gets a few days rest in bed, she 
can get sufficient mental rest after that while takiag light exer- 
cise and developing heart muscle and endurance. 

Accordingly after a few days rest (according to the amount 
of weakness) instead of the conventional five or six iveeks she 
sits up half of an hour, the next day half of an hour twice, morn- 
ing and afternoon, the next day an hour twice, and walks a few 
steps upon getting out of bed and back into it. The next day 
she gets up a little before noon and is dressed loosely and is up 
until supper time, sitting, lying down and walking about the 
room at intervals. The following day she gets up in the forenoon 



232 . ihe Plexus. 

as soon after the massage as she feels rested, and walks a great 
deal about the room or house, lying down now and then to rest, 
or she walks half a block out of doors. The next day she walks 
half a block out of doors both morning and afternoon and takes 
a rest on the bed of two hours at noon. The next day she walks 
a block morning and afternoon, the next a block and a half 
twice daily, the next two blocks twice, the next three blocks 
twice, the next four blocks twice, the next five blocks twice and 
so on. She increases the walks by a block each day, and rests 
two hours in the middle of each day, until she walks fifteen 
blocks or a mile and a half twice daily, then increases a block 
every other day until two miles are walked at a time, and after 
that the same each day. Resistance and passive movements 
twice daily, early and late, are commenced one or two days 
before she gets up, and continued and increased daily. After she 
remains up all day, or about the third week, she exercises out of 
bed, upon rising and retiring, with half pound wooden dumb- 
bells until slightly fatigued, and increases it daily as it takes 
longer to tire her. At this time it may be found desirable to 
give the massage or rubbing at bed time. In fact after the 
patient is able to walk several blocks and exercise witti dumb- 
bells and to sleep like a log, as she usually does, the massage, 
electricity and passive motions may be stopped, for they bear 
the same relation to active exercise as milk does to bread and 
meat, viz: are good as far as they go, but do not go nearly as 
far. 

When the patient can walk two miles twice daily, and exer- 
cise from ten to to twenty minutes with dumbbell Is morning and 
night, she will find that soon she will stop feeling tired, nor will 
every extra exertion she makes tire her; and when she goes back 
to her household duties they will be performed without much 
exeition and without fatigue. 

In mild cases if the patient can be persuaded out of the notion 
that everything is going to exhaust her, and will follow directions 
implicitly, it may be possible after two or three weeks to dispense 
with the nurse. The j^atient receives daily direction by the phy- 
sician about her diet and exercise, according to her feelings. 

In the mildest cases with the indigestion and nervousness 
that goes with an improper diet and indolent habits, or a want of 
physical and excess of mental exercises, she may dispense with 
a nurse and commence with the same diet and exercise as has 



Care ^Yltllo^i t Rest. 233 

been recommended above after the patient begins to go out of 
doors for a walk. Bicycle or horse backriding, croquet, lawn 
tennis, bowling, etc., may later take the place of part of the 
walking. 

6. One of the chief services of the nurse consists of occujoy- 
ing the patient's mind pleasantly while she is awake, in explain- 
ing and keeping away nervous pains, discomforts, forebodings, 
despondent thoughts, etc. The nurse should never express sym- 
sympathy, but should always respond to the patient's desire for 
sympathy by words of encouragement. The morning toilet, mas- 
sage, feeding every three hours, electricity, passive exercise, 
reading the newspaper, talking and perhaps a nap after the mas- 
sage will pretty well consume the time during the first week. 
After the patient begins to sit up the time will be occupied so 
fully that there will be no time for despondent thoughts. 

After she is discharged she must continue indefinitely the 
exercise and dieting, and her friends must be cautioned against 
sympathizing with her pains, and against encouraging her to rest 
or to eat sweetmeats or desserts, or to eat anything between meals. 

Finally the patient has been taught how to live and be well, 
and this is the most important part of the rest cure. It is the 
whole thing. 



STATE UNIVERSITY BULLETIN. 

The State University Bulletin is issued fortnightly by the 
University of Illinois, under the management of E. B. Greene, 
chairman of the Press Committee. It is sent to about J:00 High 
Schools and educational institutions throughout the state of Illi- 
nois and to about 800 papers, journals, magazines and other 
periodical publications, for the purpose of keeping the public in- 
formed as to the work of the State University in its various de- 
partments. Dr. L. Harrison Mettler, professor of physiology, 
has been appointed to take charge of the medical department, 
and he invites all the members of our faculty at the heads of the 
various departments of the medical school to send him all items 
of interest in connection with the work of the school, so that 
they may receive adequate recognition in the official organ of the 
University. 



REPORT OF TWO CASES OF SPINA BIFIDA, ONE 

OPERATED UPON— THE OTHER ASPIRATED. 

By Svenning Dahl, A. B., M. D. 

Instructor in Surgery College of Physicians and Surgeons. Attending Sur- 
geon Norwegian Lutheran Deaconess Hospital. 

Perhaps it would not be amiss to premise a short definition 
and a synopsis of the different varieties. 

Spina bifida is a partial rachischisis, the defect being limited 
to one region, or even to a single vertebra. This defect consists 
of a cleft in, or the complete absence of the vertebral arches of 
one or more, generally three vertebrae with a hernia-like protru- 
sion of the membranes of the spinal cord containing cerebro- 
spinal fluid and very often a portion of the spinal cord as well. 

The name spina bifida has reference to the deformity of the 
spine, while the name hydrorhachis refers to the fiuid contained 
in the tumor. 

Anatomically we distinguish three head forms: 

1. Spinal meningocele or hydromeningocele spinalis, i. e., a 
hernial protrusion of the spinal membranes filled with cerebro- 
spinal fluid. The authors differ as to whether the dura mater 
participates in the formation of the sac or not. This form is 
usually located in the cervical region, but may appear at the 
lower extremity of the sacral vertebrge through the hiatus 
sacralis. 

2. Myelomeningocele is the commonest form and usually lo- 
cated in the lumbar or sacral regions. The sac, i. e., the pro- 
truding part, consists only of pia mater and arachnoidea, the 
dura mater not forming any part of its dorsal portion. The spi- 
nal cord participates in the formation of the sac and generally 
in this way : It is at the upper entrance of the sac turned posteriorly 
and at the same time split up into smaller cords which are gen- 
erally found firmly adherent to the wall of the sac. Towards the 
lower end of the sac these smaller cords converge to unite upon 
returning to the spinal canal. 

Some nerve roots cross the sac while others may be seen 
springing from the smaller cords. 

A myelomeningocele is then a hydromeningocele plus a 
myelocele. 



spina Bifda. 235 

3. Myelocystocele or hydromyclocele or syringomyelocele is 
caused by a dilatation of the central canal of the spinal cord 
whereby a greater or smaller part of the cord surrounded by pia 
mater and arachnoidea protrudes forming a cystic tumor. As in 
myelomeningocele dura mater does not form part of that portion 
of the sac which is outside of the vertebral canal. This form 
may combine with meningocele forming a myelocystomeningocele 
which, however, is rare. 

The two cases I have had the opportunity to treat were as 
follows : 

Case I. Through the courtesy of Dr. N. T. Quales a male 
child, eight days old, was brought to me in August, 1896, for 
treatment of a congenital tumor of the spine. Examination re- 
vealed the following characteristic picture of spina bifida sacralis. 
The tumor, located in the median line over the sacrum, near the 
lumbar junction, was about the size of a hen's Qgg, was circular, 
sessile and fluctuating. The integument was perfect except at 
the summit where it was thin, semitranslucent and membranous. 
Upon cautious pressure the tumor would be slightly reduced in 
size, while over the greater fontanelle a bulging resulted simil- 
taneously. When the child cried it became more tense. The in- 
fant was rather well nourished, not puny as these cases usually 
are and no paralysis was present. The parents are healthly and 
have several healthy children. No family history of imperfect 
development, nor of specific diseases that might act as an excit- 
ing cause for this non- development. 

The suggestion of an operation was accepted by the parents. 

No dnsesthesia was used. The patient was supported by a 
firm cushion under the abdomen so as to place it in the knee- 
chest position in which the tumor would be the highest part of 
the body and the head the lowest, to prevent a too complete and 
too rapid evacuation of the cerebro-spinal fluid. 

The field of operation having been rendered clean a lateral 
incision, as recommended by Konig and Hildebrand, through the 
skin was -made, leaving the sac intact in the whole length of the 
tumor; a smaller incision — puncture with the knife — of the sac 
proper was then made at the inferior pole, allowing the fluid to 
run out very slowly. 

With a small retractor keeping the sac distended, the open- 
ing was carefully enlarged to the same length as the skin incision, 
when there was seen three nerves attached to the summit of the 



236 The Plexus. 

tumor, one of which probably represented tikim terminale. These 
nerves were next dissected loose from the wall and placed in the 
open groove — the spinal canal. The groove measured about one 
and one-half inches in length and one-half inch in width. Three- 
eighths of an inch from the margin of the groove an incision was 
carried through the sac-w^all, the portion outside of this incision 
removed and the portion inside of it dissected free. Thus two 
flaps were obtained, one on each side of the canal. With a pledget 
of cotton wrapped on a toothpick, the lining endothelium was 
carefully penciled with equal parts of tincture iodine and absolute 
alcohol. These flaps were now brought together over the groove 
and kei3t approximated by a continuous suture of catgut. The 
superfluous skin with its underlying fascia was then trimmed off 
and the flaps united by interrupted suture of silkwormgut. 

No oozing. A dry dressing was applied somewhat firmly. 

Throughout the operation the little patient did not give any 
evidence of suft'ering. 

Three days after the operation I saw the wound, it was dry 
and in an excellent condition. On the eighth day the sutures 
were removed, the w^ound had healed without any suppuration. 

Case II. A female infant, two months old, was brought to 
the Norwegian Deaconess Hospital September 14th, 1899, for 
treatment of a congenital tumor of the spine. Examination re- 
vealed a rather large, sessile, ovoid, fluctuating tumor, located in 
the sacral and coccygeal regions, measuring about two inches in 
the length of the body by one and a half in the transverse direc- 
tion and jDrojecting about one inch from the surface. The whole 
tumor was covered with perfect integument, no area medullo- 
vasculosa, nor any cicatrix being present. Other symptoms the 
same as in case I. The family history did also here not disclose 
anything that might act as the exciting cause of this abnormality. 

The baby was small, jooorly nourished and fretful, and on ac- 
count of its close proximity to the arms I did not deem it advis- 
able to perform a radical operation in this case, owing to the ex- 
treme difficulty of keeping a wound aseptic in this locality, there- 
fore I decided to try aspiration. 

The patient was placed in knee-chest position in the same 
way as in case I; the parts made as aseptic as possible, a fine 
aspirating needle introduced in an oblique direction into the 
tumor on its right side. This puncture into the lateral aspect of 
the sac was made for the same reason as the lateral incision in 



Sjv'na Bifiila. 23« 

•case I in order not to injure any nerve or part of the cord that 
might adhere to the summit of the sac. 

The sac was wholly evacuated and after the evacuation one- 
half of the following mixture was injected: 

Tincture of Iodine 
Alcohol absolute a. a. 

Collodion seal and as firm pressure as was consistent with- 
the frailness of the patient was applied. The mother was in- 
structed to return with the baby in 10 days which she did on 
Sept. 24th. 

The mother stated that the baby had not been so cross after 
the operation as before and nursed better. We also thought we dis- 
covered an improvement in its appearance . However, on removing 
the bandages and dressings the tumor was seen to have regained its 
original size and tensity. The aspiration was repeated as was 
also the injection, the amount being increased to one drahm. The 
mother was instructed to bring back the child on October 3d, 
which she did. 

It was now apparent to all that the baby w^as improving in 
general health. On removing the dressing the tumor was found 
of the same size as before, but not quite so tense, indicating that 
the injected fluid had succeeded in checking the hypersecretion 
to some extent. After a complete evacuation two drahms of the 
above mixture was injected and the parts dressed as before. The 
mother was asked to bring the patient back October 13th, which 
she did. 

Baby looks now better nourished with rounder form. Mother 
stated: "It feels better and better and gets stronger and 
stronger." Upon removing the bandages this time we found the 
tumor entirely collapsed, containing no fluid whatsoever. The 
firm pressure was again applied and the mother told to return 
with the infant on October 23, when we found no fluctuation but 
the superfluous skin at the site of the tumor was beginning to con- 
tract so that the folds had decreased in number, showing beyond 
a doubt that obliteration of the sac had taken place. Nov. 20th I 
saw the case last, it was thriving very nicely. 
822 N. Western Ave. 



ARE COUNTRY DOCTORS HARD THINKERS? 
By Edward C. Seufert, M. D. 

Adjunct Professor of Histology and Microscopy, College of Physicians and 

Surgeons, Chicago. 

Statisticans have not yet proved that brains are indigenous 
to any particular region. In fact, transportation being just as 
cheap for a full, as an empty head, there is no embargo on the 
freest possible distribution of the commodity over the country. 
Surroundings, too, have a great deal to do toward developing 
wit and mental power. In olden times the favorite simile for 
progress was the best foot forward. Now it is the best head 
forward. We have reason to believe that heads are pretty 
evenly distributed over the' country. At least they have been 
bobbing up quite promiscuously and plentifully over the general 
fields of medical literature, and made as good a showing in one 
locality as in another. 

The quality of grain can speak for itself if left to itself. 
It is not the question where you come from so much as what you 
are. The seed always produces its kind, and generally the 
hardier the soil the sweeter the fruit. 

Emergencies and surroundings are everything to bring out 
the qualities ,of mind or body. Nothing quickens a man's per- 
ceptions more certainly, or develops more surely his inner 
practical resources, than the consciousness that he has to think 
with his own brain and act with his own hand. Thinking, and 
hard thinking at that, becomes a habit with such men, and the 
working out of their own salvation is an acknowledged necessity. 

When any writer presumptuously says that a country doctor 
never does any hard thinking, he has evidently never met even 
the average representative of that class. 

All other things being equal, the only difference between the 
metropolitan and rural practitioner is in the surroundings. The 
former is in a position to have plenty of help and very many, if 
need be, to think for him; the latter is generally alone in an 
emergency and has to do his own thinking. The country 
doctor's mental guy-ropes are his own experience and that of the 
marshalled authorities in his library; the metropolitan prac- 




EDWARD 0. SEUFERT, M.il). 
Adjunct Professor of Histoloiry and Microscopy, College of Physicians 
Mild Surgeons, Oliicaaro 



Are Count ry Doetors Hard Thinkers. 239 

titioner can, if he chooses, fasten the different tendrils of his 
web to the door-posts of all the experts and specialists in his 
neighborhood. Counsel in the city is the rule, in the country it 
is the exception. 

The country doctor is expected to be ready for anything, and 
he generally is. Besides being a student he is expected to be 
thoroughly practical in all his methods. He has not, it is true,^ 
all the modern appliances at his command. One old-fashioned 
speculum may do all the business of two or three generations, 
occupying large and small compartments alike, common to 
young, middle aged, and old, changing in office from the grand- 
mother to the granddaughter, and yet the average of cures for 
leucorrhoea, abrasions of the os or cancer of the cervix, may 
even equal those obtained in the Woman's Hospital. 

The same might be said for other departments of his 
practice. He cannot pick his instruments from hundreds in the 
hospital closet, cannot have skilled assistants at every turn, and 
antiseptic solutions everywhere, nor has he skilled attendants to 
watch for temperature rises, secondary hemorrhages and the 
like. His fracture cases are generally miles from his office with 
no friendly assistance at hand to loosen the damaging grip of an 
unyielding bandage. 

It goes without the saying that the country doctor must of 
necessity learn to help himself, and if he cannot do it with his 
brains he certainly cannot with his hands. The instrument is 
one thing and the brains behind it is another, and, alas! very 
often we may say vice versa. The hard, square thinking gener- 
ally strikes the balance the right way . 

During his solitary drives he must do the mental sorting of 
his cases and place each in its own category. And here is where 
the thinking must come in, and where seeming difficulties must 
smooth themselves to the common- sense level of practical 
experience. 

It is within the exxDerience of many a country doctor that 
between miles of drive he may meet, single-handed, every 
variety of disease in any of the different departments of practice. 
At one end of the road may be a breech presentation, at the 
other a herniotomy. His ear must as perfectly recognize the 
crackling rale of an ominous pneumonia, and the husky sibilance 
of an urgent croup, as the grating crepitus of a fractured bone, 
or the clicking ring of sound and stone. To string these varied 



"240 The Plexus. 

experiences into consistent practical work, requires something 
more than shallow reasoning or careless guess work. And yet 
we are fain to believe that this is the ordinary business of the 
general practitioner in the country. It is this training, forced 
upon him by circumstances, which must necessarily make him a 
reasoning and practical man. 

He is to our mind the beau-ideal of a general practitioner, 
forced to be ready for everything, and afraid of nothing. The 
whole body belongs to him, and he does his best with each part. 
Every subject connected with its diseases must necessarily 
interest him. He is, iier force, a reader, a thinker, and a doer. 
His very habits make him the best judge of the practical work 
of others, as he must weigh the evidence in favor of new 
methods before he dares assume the responsibility of their trial 
as he alone will be accountable for evil results. It does not 
matter how much of the lung is involved in inflammation, the 
patient's friends watch for the fever to be reduced. Nor do they 
care to know the character of a urinary cast so long as proper 
diuresis is induced. The cause of a diarrhoea is of no interest to 
the patient if the discharges are not stopped. The man with 
retention of urine may never have heard of the prostate gland, 
but he wants to urinate. The good woman with the momentary 
expectancy of maternity does not care for the presentation, so 
long as she can get the baby in good time. 

In all his cases he is brought face to face with his patients. 
He must treat all their diseases, and with reasonable success. 
To do this must require some intellectual effort. If we judge 
only by the results, we are free to make comparisons. Certainly 
his statistics do not jierceptibly weigh down the mortuary record. 

"We are tempted to take sides with the country doctor 
because, unfortunately for him, he does often enough assert his 
claims. When the latter is the case he generally writes some- 
thing worth reading, and founds his observations on what he has 
seen, what he knows, and what he has thousrht out for himself. 



FRAU GEHLl. 
E. F. Snydacker, M. D. 

Of the many interesting characters, I have learned to know 
abroad, perhaps the oddest genius is Prau Gehli. A kind provi- 
dence surely sent her to Vienna as an aid to those who are 
seeking knowledge in laryngological and naso-pharyngeal fields. 
She is by no means ornamental; even her greatest admirer could 
not claim that for her. She carries the weight of seventy years 
on her bowed back, seventy Vienna winters have traced heavy 
lines on cheek and brow. She is sadly lacking as to one eye; 
that useful organ having for many years been supplanted by a 
black patch. It will convey a vivid idea of her walk, at least to 
my rural readers, when I tell them that it most resembles the 
gait of a horse afflicted with spring-halt. In other respects she 
looks like any other thin, wrinkled, worn-out old woman of 
seventy. Nevertheless this old Prau Gehli has proved an 
invaluable friend to many an American physician seeking knowl- 
edge in Vienna. 

For the sum of one gulden (about forty cents) the old lady 
sells you the use of her larynx, pharynx, naso-pharynx, eusta- 
chian tube, esophagus or stomach for one hour. This in itself 
would be a useful and praise worthy profession, but it is not 
merely the objective which Frau Gehli placed at your dis- 
posal, • it is also the subjective. She has more than organs, 
she possesses knowledge, intelligence and endless patience; all 
she asks in return is one gulden an hour and gentleness in 
manipulation. 

Generations have practiced on the old lady, many have 
become famous, many are dead, but she still lives to tell about 
them, and to interest each new comer in methods learned by 
years of experience and observation. Her knowledge of the 
anatomy of the larynx, pharynx and naso-pharynx is perfect, 
her tolerance to manipulation is wonderful, but most remarkable 
of all is her power of localizing sensation in those regions. 
If you put a probe into her larynx and touch a certain spot she 
is able to tell you exactly what spot you have touched. I know 
t is impossible to deceive her, for I have often tried it. If you. 



242 The Phxns. 

touch the right vocal cord with the probe and say: "Now, Prau 
Gehli, I am on the left cord," she will invariably answer, 
"Aber, Herr Doctor, sic sind an dem rechten Stimmband.'" 

It is the same in the naso-pharynx, she can tell you whether 
you touch the septum, the posterior end of one of the turbinates 
the mouth of the eustachian tube, the vault of the pharynx or 
the fossa of Rosenmiiller. 

She never uses cocaine — before beginning work she swabs 
out the larynx and pharynx with a weak salt solution, and this 
swabbing is not the least of her feats; with right hand or left 
inditferently, she passes the pinsel into her larynx and thor- 
oughly swabs it out, only coughing when the pinsel passes 
between the cords. 

If you wish to work on the larynx, the work begins, I was 
about to say, on the epiglottis but it does not. It begins with 
proper placing of the light, the holding of the head, the manner 
of holding and manipulating the instruments, and although you 
may have done the things many times and thought yourself 
familiar with the work, it is astonishing how much surer and 
lighter your touch will become under her instruction. When you 
hold and manipulate the instruments to suit her, then the task 
is, either with a probe or pinsel to touch certain points on the 
epiglottis; when you can do this with certainty you go into the 
sinus pyriformis, next you proceed onto the arytenoids and 
thence by easy stages into the larynx. 

When the old lady deems you sufficiently expert, she allows 
you to pass a stenosis tube or to do an intubation. The latter 
performance she is not especially fond of, and it seems to 
distress her most. When you have been working with her for 
some time, you will say to her: "Now Frau Gehli, I think we 
will begin to remove foreign bodies from the larynx.'' Then 
perhaps she will ask in her Vienna dialect, if you have ever 
removed foreign bodies from the larynx, and if you were grad- 
uated from P. & S. perhaps you will lie and say "yes." Then 
she will cogitate a bit and say: "Well, I think we will wait a 
few times more, and some day when you do very well with the 
pinsel, can touch every part of the larynx easily, and your hand 
is light and steady, then we will begin." 

So at last, you begin to remove foreign bodies from the 
larynx, and now I can assure you Prau Gehli's job is not as easy 
as that of a Chicago politician. 



Frau Gehli 243 

The foreign body consists of a small bead fastened to the 
end of a silk thread; your task is first to get it in, and then to 
get it out. 

If you know the Schrother instrument for the removal of 
foreign bodies, you know that it is a big thing and a long thing 
to get down between the back of the tongue and the posterior 
wall of the pharynx, at the same time passing well over the, 
epiglottis— you will also know that, unless you are accustomed 
to it, it is no easy thing to chase an object by means of its 
image in the mirror, and often you will be surprised, and poor 
Frau Gehli will be even more surprised, to find that when you 
close your instrument, surely expecting to have the foreign 
body within its grasp, you have instead a fold of mucous mem- 
brane or an arytenoid, or perhaps a vocal cord; at such times 
the old lady is apt to execute a clog dance, remarkable for one 
of her years, and to express her displeasure in terse and forcible 
German. But it is like swimming, skating, or riding horse back, 
you keep on and soon you wonder what was hard about it and 
why everybody can not do it. 

The work in the naso-pharynx proceeds along much the 
same lines; you learn with a curved probe accurately and 
lightly to touch the different parts. Perhaps you have designs 
on the eustachian tube; in that case you boldly enter with a fine 
boughie. Perhaps your affinity lies on the posterior end of a 
turbinate, and you, imagining you have a deadly hypertrophy or 
an elusive polyp to do with, skillfully pass the snare about it. 

So even from this brief and hasty description you can 
readily see what a treasure trove Frau Gehli is to one having 
laryngological or naso-pharyngeal aspirations. 
Lederer Grasse 22, Vienna. 



A CASE OF ECZEMA. 

Wm. Belitz, M. D. 
Editor Pi^exus: — In response to the invitation to contribute 
something for the Plexus, which will be of interest, I must say 
that as a novice in the field of action my experience is too limited 
to bring forth anything, very instructive, for the beginner has 
not the privilege to try original, new methods of treatment of 
disease, except when driven to it by persistent failure with known 
methods, which will nob often be the case, although twice since I 
began practicing I had to drop the works on medicine and retreat 
to the f andamental branches, Physiology, Anatomy aad Materia 
Medica for cover. One and one-half years' time in practice is 
not long enough period for comparison, otherwise pointing out 
the differences between the student's toils and the first efforts of 
the young practitioners would form an instructive theme, and 
perhaps a profitable one for the seniors. As I can bring nothing 
directly instructive at present, I will at least try to present a 
curiosity: About six weeks ago a farmer living in one of the 
small ravines which branch off from the valley of the Mississippi, 
asked me to take a drive over the bluffs, to ascertain whether I 
could do anything to help his sick wife who was not expected to- 
live much longer. The patient had been most of the time sick 
abed for the last eighteen months. She had borne a child during 
that time. The family history points out vividly the rheumatic 
tendency, the patient stated that she had also suffered from rheu- 
matism some years ago. She was troubled with an eczema, of 
the obstinate variety since early childhood, being seldom free 
from it. The patienfs age is now about 34 years. By her last 
physician she had been treated for kidney disease. On this, my 
first visit, I found almost her whole body covered with a coating 
of eczema, highly inflammatory, of leathery solidity, and trav- 
ersed by fissures of various depths, some of them bleeding. In 
places there were collections of exudate and the odor set free was 
very unpleasant. Contact of the body surface at any point caused 
pain, darting pains in the muscles of the back and chest were 
complained of in particular. The temperature was slightly above 
100*^ F. The pulse beat about 115 a minute, was feeble andirregu 



A Case of Eczema. 245 

lar in volume Examination of the heart revealed a marked sys- 
tolic murmur over the apex, suggesting mitral leakage. There 
was some oedema around the ankles, where the eczema permitted 
it to "exist. The appetite was feeble and selective, digestion 
seemed to be below par, judging from facts elicited. There was 
some looseness of the bowels. The distal articulation of the ring 
finger showed marked hypertrophic deformity, which had made~ 
its appearance but a short time previous and there was also be- 
ginning enlargement on the middle finger of the same hand. The 
patient told me that before that date she had been troubled at 
times by a tumor somewhere in the abdomen, which had caused 
her considerable suffering. Owing to the rigidity and hardness 
of the abdominal walls from present inflammation successful 
search could not be made for the supposed tumor. Proper pal- 
pation would have been impossible even under anaesthesia. Per- 
cussion was painful and resulted in nothing definite. Any slight 
change In position would make the patient cry out through pain. 
For the rest nothing was the matter with the patient at the time. 
By way of treatment alkalies were ordered on general principles, 
tincture of fox-glove for the heart and a suitable ointment for the 
eczema. The people were asked to send in a specimen of a 24 
hours' collection of urine. Later the results of the urinalysis 
were as follows: 

Quantity passed, 1800 c.c; color, normal; reaction, alkaline 
(from medication) ; specific gravity, 1028; no trace of albumen by 
3 tests; no sugar, Purdy's; only a feeble reaction for indican; no 
bile; no blood. 

Which result made me exclude all forms of nephritis for the 
time At the second visit the swelling of the joints referred to 
had almost disappeared, though they had been of bony hardness 
and painless. The toe-nails were being shed, the eczema had be- 
conie less painful and the oedema had vanished. The tempera- 
ture was as before, the pulse had not improved, the anorexia had 
increas(!d, the apparent weakness was extreme. The medication 
then was changed to a combination of hematic, tonic and small 
amount of alkalie and the dosage of fox-glove raised. At the 
third visit, a week later, the eczema permitted large areas of 
nearly normal skin to reappear, but beyond this there was no im- 
provement. A new element had crept in. There was pronounced 
ascitis and the patient complained of severe pain to the left and 
above the umbilicus; the slightest touch there would make the 



246 The FJexus. 

sufferer scream. The liver occupied its normal position and did 
not seem to be enlarged. By inspection and light palpation and 
percussion no tumor could be made out by me in any region of 
the abdomen. Hydragogue cathartics were objected to, so the 
abdomen was aspirated. Each cupful of the ascitic fluid with- 
drawn seemed to increase the abdominal pain and when about 
1500 c.c. had been removed, the procedure had to be stopped as 
the patient seemed to be badly used up. The fluid was clear, 
limid and of a faintly yellowish color. After the tapping I hoped 
to find the fata moi'guna tumor in shape of a floating kidney, but 
it refused to be found, the stile remaining ascitis and the pain 
prevented exhaustive examination, and it was too dangerous to 
use an anaesthetic on the j^atient then. I ordered heart stimulant, 
used dry heat against the pain and left an opiate to be used only 
when absolutely necessary. The case was simply getting com- 
plicated. The heart stimulant did its work and in a few days the 
patient was improving in that tlie ascitis became a little dimin- 
ished and the abdominal wall softer, for all that palpation and 
percussion would reveal no tumor. The pulse did not change 
much in rate and strength. A night cough developed and once 
there was blood expectorated. That w^as the last I heard of the 
case (about 10 days ago), but the patient is living on and may 
have elaborated new features of interest. It is therefore too 
early for me to complete the diagnosis of the case. The peculi- 
arity of this story of misery is that no one is happy in the end; 
it is peculiar also in that it is related without ending up with the 
report of such effective treatment that all evil had to vanish as 
by magic. One thing however is certain; the treatment of 
eczema is not simple when it has a sufficient number of complica- 
tions connected with it. 
Cochrane. Wis. 



THE PLEXUS 

THE OB^FICIAL ORGAN OF 

THE COLLEGE OP PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 
UNIVERSITY OF ILLINOIS. 

Editor, H. C. WADDLE, '03. Busitiess Mgr. E. J. MERKI, '02. 

Class Editors: 

H. B. HAMILTON, '00. CHAS. M. NOBLE, '01 . PALL E. GRABOW, '02. 
GUY C. WALFLE, 03. 



Faculty Department, DR. W. A. PUSEY. Athletic Editor, A. DONKLE, 01. 

Aluiuui Editor, DR. C. C. O'BYRNE, '94. Clinical Department, DR. A. E. GANSEL. 

Publishers, ----- MERKI & WADDLE. 

Sttbscriptioti $1.00 per Aimum in advance. Single copies, 15 cents. Issued Monthly 
Send all remittances and communications as to subscriptions and advertising to E. J. 
MERKI, Business Manager, S13 W. Harrison St. 

Entered at Chicago Post OfHce as Second-Class Matter. 

Any subscriber desiring the Journal discontinued at the expiration of his subscription 
should so notify the Publishers; otherwise it will be assumed thai the subscription is to be 
continued and the .lournal sent accordingly. 

Contributions of matter suitable for publication are invited, and should be sent in not 
later than the 25th of the month previous to that of publication. The publishers willnot hold 
themselves responsible for the safe return of MSS. unless sufficient stamps are forwarded 



It gives US pleasure to print in this issue of the Plexus a let- 
ter from Dr. E. F. Snydecker, who is doing post-graduate work 
in Vienna. We are always pleased to be remembered in this way. 

* 
We announce with pleasure the fact that there seems to be a 
gradual increase of interest, both on the part of the Alumni and 
student body, in the Plexus. The interest is shown by the in- 
creased subscription list, by the sending in of articles for pub- 
lication, and lastly, but by no means of the least imjjortance, by 
the sending in of the subscription price. We are: endeavoring to 
give our readers an interesting and up-to-date periodical, but it 
requires the sheckles to do so. If you are aware of an indebted- 
ness to the Plexus it will confer a favor. upon the managers to at- 
tend to the matter at once. 



2-18 The Plexus 

With this issue of the Plexus, there has been quite a decided 
change in the control of the Plexus as it has been purchased by 
the faculty and will hereafter be under their direct control, 
through their Plexus committee. The present committee con- 
sists of Dr, T. A. Davis, Chairman, Dr. D. A. K. Steele and Dr. 
A. H. Brumback. 

Not only has there been a change in control but there has 
also been a change in business manager, as E. J. Me^ki takes the 
place of G. G. Dowdall. 

Mr. Dowdall has proven himself a rustling business manager 
as can easily be seen by glancing at the pages of advertisements 
of the Plexus and a comparison with same when he took charge. 

Mr. Dowdall takes charge of the advertising department of 
Dr. G. F. Butlers new medical journal -'The Doctors" Magazine'' 
and Dr. Butler is to be congratulated in securing so valuable a 
man as Mr. Dowdall for this department. 



Dr. C. C. O'Byrne takes charge of the Alumni editorship be- 
ginning with this issue. Dr. O'Byrne has a wide acquaintance 
with the alumni and is a man well equipped for the work. 

The Alumni work for the last six months has been done by 
Dr. W. A. Evans, retiring Secretary of the Alumni, and we great- 
ly appreciate the interest Dr. Evans has shown in the Plexus. 

* 

The fifty medical inspectors for the Chicago schools, who 
passed the examination recently held by the Board of Education 
began their work Monday, Jan. 8. These inspectors were ad- 
dressed by Dr. W. S. Christopher, member of the Board of Edu- 
cation, and Instructor in Children's Diseases at the college of 
Physicians and Surgeons, before taking up their work. 

Dr. Christopher emphasized the fact that they were not to 
take the place of the family physician, in giving advice as to 
treatment, etc., but they were to look out for the spreading of 
infectious diseases; they were not to look after the ailing child 
but to protect the well child . 

The following instructions were given to each inspector: 

"The pupils to be inspected will be referred to the inspector 
by the principal for two reasons: (a) Those who have been ab- 
sent four or more consecutive days; (b) those in school whom the 



Editorial. 249 

principal may suspect to be suffering from contagious disease. 
These two classes must be kept separate in the reports. 

The inspection is to be made with reference to transmissible 
diseases only, and examination is to be made for the following- 
diseases : Scarlet fever, diphtheria, measles, smallpox,- chicken- 
pox, tonsilitis, lice, ringworm or other transmissible diseases o5 
the skin and scalp and transmissible diseases of the eyes. 

Scarlet fever cases must be excluded until desquamation has 
ceased. Diptheria cases must be excluded until throat culture 
shows the absence of the Klebs-Loeffler bacillus. 

Cases of severe tonsilitis must be excluded on the clinical 
evidence alone, and throat cultures made for further diagnosis. 

Cases presenting suspicious throats, but not definit evidence 
of disease clinically, must have throat culture made, allowed to 
return to their classes until the culture has been examined, and 
only excluded in case the bacteriological examinations shows ex- 
clusion to be necessary. 

In making inspection care must be used to disturb the child 
as little as possible, and throat cultures are to be made only when 
good reasons therefore exists. 

In making throat examinations the wooden tongue depressors 
supplied must be used to the exclusion of all other tongue de- 
pressors. Each tongue depressor must be used only once. 
Aseptic methods must be employed in all examinations. 

If a child is excluded brief but sufficient reason therefor must 
be written on the exclusion card. 

Inspectors are forbidden to make any suggestions as to the 
treatment or management of pupils who are sick. This is im- 
perative. 

Each inspector must visit all the schools to which assigned 
every school day." 

Dr. Christopher deserves a great deal of credit for his un- 
tiring effort to have the schools of Chicago protected as far as is 
possible, from infectious diseases, as it has been through his effort 
that the appointment of these medical inspectors has been brought 
about. 



250 The Plexus. 

We are desirous of placing ourselves on record as thoroughly 
opposed to the anti-vivisection bill introduced into Congress by 
Senator Gallinger. 

If in the minds of some, there is an unnecessary killing of 
animals, it seems to us that the first step is to limit the killing of 
animal to scientific purpose rather than the prohibition of the 
same. Should the Gallinger bill be passed and similar bills be 
taken up by the different state Legislatures it would be a great 
backset to the science of medicine. 

We print below a letter from Dr. W. W. Keen, President of 
the American Medical Association: 

The cause of humanity and of scientific progress is seriously 
menaced. Senator Gallinger has again introduced into Congress 
the Bill for the "Further Prevention of Cruelty of Animals in the 
District of Columbia,"' which he has so strenuously and mis- 
guidedly advocated in the last two Congresses. It is Senate Bill 
No. 34. Twice the Committee on the District of Columbia has, 
also unfortunately and misguidedly, reported the bill with a 
favorably consideration. It is speciously drawn to seem as if it 
were intended only in the interest of prevention of cruelty to 
animals, but the real object is twofold: 1, to prohibit vivisection 
and, 2, to aid the passage of similar bills in all the state legis- 
latures. 

It hardly needs to be pointed out that this would seriously 
interfere with or even absolutely stop the experimental work of 
the Bureau of Animal Industry and the three medical departments 
of the Government, the Army, the Navy, and the Marine-Hospital 
Service. The animals themselves might well cry out to be saved 
from their friends. No more humane work can be done than to 
discover the means of the prevention of diseases which have 
ravaged our flocks and herds. All those who raise or own 
animals, such as horses, cattle, sheep, pigs, chickens, etc., are 
vitally interested in the preservation of their health and the pre- 
vention of disease. 

The inestimable value of these scientific researches as to the 
prevention and care of disease among human beings it is super- 
fluous to point out. Modern surgery and the antitoxin treatment 
of diphtheria alone would justify all the vivisection ever done. 

As my attention has been called officially to the introduction 
of the bill, I take the opportunity of appealing to the entire pro- 



Editorial. 251 

fession of the country to exert itself to the utmost to defeat this 
most cruel and inhuman effort to promote human and animal 
mi ery and death and to restrict scientific research. It is of the 
utmost importance that every physician who shall read this appeal 
shall immediately communicate especially with the senators from 
his state, shall also invoke the aid of the representatives, from 
his or other districts in his state, and by vigorous? personal efforts 
shall aid in defeating the bill. 

It is especially requested also that all of the national, state 
and county societies, at their next meeting, take action looking 
toward the same end. If regular meetings are not soon to be 
held, special meetings should be called. Correspondence is in- 
vited from all those who can give any aid. 

The committee on the District of Columbia consists of 
Senator James McMillan, Michigan, Chairman, and Senators J. 
H. Gallinger, New Hampshire ; H. C. Hansborough, North Dakota; 
R. Redfield Proctor, Vermont; J. C. Pritchard, North Carolina; 
Lucien Baker, Kansas; C. P. Wetmore, Rhode Island; C. J. Faulk- 
ner, West Virginia; Thomas S. Martin, Virginia; Wm. M. Stew- 
art, Nevada: and Richard Kenney, Delaware. Personal letters 
may be addressed to them or to other senators. Petitions should 
be addressed to the Senate of the United States. 

W. W. Keen, M. D. 
President American Medical Association. 



PUBLICATION BY DR. BUTLER. 
Dr. George F. Butler, professor of Materia Medica and 
Chemical Medicine in the School of Medicine of the University of 
Illinois, has entered the field of general literature with the pub- 
lication of his "Love and Its Affinities.*' The interesting ques- 
tion of the relationship of love, the emotions, and religious en- 
thusiasm is studied from a historical and scientific standpoint and 
reveals much thought and wide reading on the part of the author. 
The treatment of the subject is chaste and ]3oetical, with a vein 
of pure and lofty idealism running through the whole. The book 
is issued by the Chicago Medical Book Company. — University 
Bulletin. 



CLINICAL LABORATORY DEPARTMENT. 

W. E. COATES, M. D. 

Medical Society of the University of Illinois. — 

This society, now in the third year of its existence, seems to 
be in a flourishing condition if we can judge from the impression 
made by a recent visit. The membership is made up from the 
student body of the P. & S. In the quality of the work pre- 
sented at its meetings, tlie attendance and the discussion follow- 
ing the presentation of papers, the society compares favorably 
with many older and more pretentious medical societies. 

As a training school for future physicians who expect to take 
an active part in city, county, state or national organization, 
nothing that we know of offers a better preparation than an 
active participation in the work of this society. 

A paper by Mr. Bremken, presented with microscopical 
demonstrations at the last meeting, is published below. 

Mr. Soegard also gave an interesting and instructive demon- 
stration of the X ray apparatus and its uses in modern surgery. 

The work of the society should receive the cordial support of 
every member of the faculty and the student body of the P. & S. 
To the clinical laboratory the society members can always look 
for hearty support and encouragement. Students who desire to 
work up and report interesting cases with microscopical or path- 
oligical demonstrations should not hesitate to avail themselves 
of the laboratory material, histories and references. The labo- 
rator}' aims to encourage just this kind of work and possesses a 
Avealth of pathological material that offers an unfailing source for 
valuable contributions to the work of the medical society. 

THE KLEBS-LOEFFLER BACILLUS AND ITS DIFFERENTIATION, WITH DEMON- 
STRATION OF SPECIMENS: PRESENTED BY ARTHUR BREMKEN AT THE 
MEETING OF THE MEDICAL SOCIETY OF THE UNIVERSITY OF 
ILLINOIS, JANUARY 6, 1900. 

Theclinical picture of diphtheria was first clearly described by 
Bretonneau in 1^20, who believes the disease was known in Homer's 
time as Ulcera Syriaca sen Aefjyptiaca. 

We read of great epidemics during the 17th and tSth centuries 
designated as Garrotillo, Slorbus stranrjulatoriiun in Spain and Italy, 



Clinical LaJ>o rat or y Department 25 

and anf/ina maligna and gangrenosa or croyp in more northern 
countries. 

The first culture-experiments were made by Edwin Klebs in 
1H72. He inserted a sterilized capillary glass tube into the diph- 
theritic membrane of a child who died of this disease and inocu- 
lated a medium of fish glue, contained in glass trays, finding, 
many colonies of small bacilli. 

He was the first to point out the parasitic nature of diphtheria 
which had its origin in the growth of a micro-organism upon the 
mucous membranes. 

In 1875 at Prague, he repeated his culture experiments, using 
Q^g, albumen for a culture medium, but at that time he found 
mostly coccus forms. The cases in which he found the micro- 
cocci were probably not diphtheria. 

In 1880 Oertel followed with a similar expression of opinion. 

In 1883, Klebs, who had then studied the Zurich epidemics of 
diphtheria, announced before the Second Congress for Internal 
Medicine at Wiesbaden, that in all true diphtheria cases he found 
in the membranes short bacilli, not quite as long as tubercle- 
bacilli, but thicker, with swollen dark staining ends; that these 
bacilli showed from 2-4 spores, w^hich stained readily by methy- 
lene-blue. 

We know today that the dots which he saw" staining deeper 
than tlie ground substance of the bacillus are not spores, but 
globules of chromatic substance. These dots furnish some of the 
most characteristic features in the differentiation of the diphtheria 
bacillus. 

The foremost clinicians did not accept the local origin and 
causative factor of the disease until this Congress at Wiesbaden 
in 1883, a period of eleven years after Klebs' first announcement, 
and even after that year a bitter contest swayed opposing ele- 
ments for years. 

In 1884 Loeffler verified Klebs" statements, finding small 
clumps of bacilli near the surface of membranes. The deepest 
layers over the vessels of the mucosa contained no bacilli. Above 
the latter he found a layer rich in cells between which diphtheria 
bacilli were found in clumps. No bacilli were found in the in- 
ernal organs, an observation which Klebs had announced pre- 
viously. The bacilli he described were identical with those of 
Klebs, and yet, Loeffler became doubtful again when he found 



254 The Plexus. 

similar bacilli in the mouth fluids oi a healthy child. He did not 
satisfy himself until 1887 that he had worked with pure cultures 
of the pathogenic bacilli in his former experiments. 

ANIMAL EXPERIMENTS. 

The following experiments were made at the Klebs' Patho- 
logical Laboratory under the directions of Dr. F. Zeit. 

Mice and rats proved immune. Guinea pigs injected subcuta- 
neously were sick on the next day and died on the second to the 
seventh day; no bacilli were found in the internal organs. Only a 
few could be demonstrated in the swollen tissues where the inocu- 
lation had been made. It was clear that a production of toxin in 
loco took place, which caused death by absorption into the system. 
Simple application of diphtheria bacilli to mucous membranes of 
animals is usually unsuccessful, unless there exists some abrasion 
or solution of continuity, microscopic or anatomical. 

The best results are obtained by subcutaneous inoculation of 
guinea pigs with 1 c.c. of bouillon culture. The injection is 
made into the subcutaneous tissue of the abdominal wall, and the 
wound shows on the same day diffuse swelling; on the second day 
the animal does not touch food, the respiration is rapid, the hair 
is standing upright, and the wound is still swoolen. Death usually 
takes places after 24-68 hours. 

If the animal lives longer, in a few days it becomes rapidly 
emaciated and the wound is covered by a grayish- white mem- 
brane containing diphtheria bacilli. The surrounding subcu- 
taneous tissues are oedematous and show numerous hemorrhages. 
The kidneys and adrenals are hyperaemic, with some pleural exu- 
date. The internal organs usually contain no diphtheria bacilli, 
pure cultures being reobtained from the areas of hemorrhagic 
oedema. 

Kiebs was the first to point out the absence of bacilli in the 
internal organs and that the symptoms produced were due to a 
poison circulating in the blood and lymph, which had its origin 
in the growth of bacilli at the seat of inoculation, where alone 
the bacilli could be found. Frosch, Babes, Kolisko, Paltauf and 
Escherich have since shown that they may occasionally be found 
in internal organs, but it is now well recognized that if so found 
in exceptional cases they do not propagate there to any degree. 

Biology: — Klebs-Loeflier bacilli grow best in the albuminous 
media in the presence of oxygen (aerogenic), the optimum tem- 



Clinical Lahoratory Department, 255 

perature ranges from 33^ to 37° C. Their virulence is reduced 
between 37° and 40"^ C. A temperature of 60° C for half an hour 
kills the bacillus. Certain secretions, such as ooze out of vessels 
affected by the specific toxins are favorable to their growth. 
These exudates which produce a fibrinous membrane, are usually 
covered by thick rows of bacilli and contain some individual^ 
bacilli nests. The exudate lifts off the epithelium of the mucosa, 
which represents the first seat of infection, and this explains 
why most of the bacilli are found on the surface of the mem- 
brane, and not in the deeper layers, evidently an effort of nature 
to prevent resorjDtion of toxins. Layer after layer of fibrin is 
thrown out between the membrane and mucosa, which contain no 
bacteria. Klebs also showed that the greatest number of bacilli 
and the most dangerous areas for toxin absorption and the 
spread of the disease, are found at the edges of the membranes. 
Here the mucosa is only covered by some thin mucus, and in this 
virulent and rapidly growing colonies are found, which constitute 
the dangerous element. 

Virulent Klebs- Loetfier bacilli may be found before the ap- 
pearance of a membrane, and for many days after, it has dis- 
appeared from the throat. We have seen virulent bacilli 60 days 
after the disappearance of all membranes. There are some diph- 
theritic anginas in which no membrane forms, but in which viru- 
lent bacilli are found. This lack of characteristic fibrinous exu- 
date is believed by some to be due to partial immunity, but the 
value of this explanation diminishes from the fact that these 
cases do at times terminate fatally, whether death is due to diph- 
theria bacilli or some intercurrent or mixed infection, such as the 
streptococcus or staphylococcus has not been demonstrated as yet. 
There is one observer (Bernheim) who believes that death in all 
cases is due to the streptococcus. 

A few cases are quoted in literature where virulent bacilli 
were found in the throat without producing clinical symptoms or 
pathological anatomic changes. There are those among whom 
are competent observers who think that the true Klebs- Loeffler 
bacillus rarely exists, in healthy throats. Again there are those, 
who from observations, have stated that in a large percent of 
apparently normal individuals without any appreciable lesions in 
the throat they have found the true Klebs-Loeffler bacillus, with- 
out being attended by clinical manifestations. With these opin- 



256 ^^'e Ple.cits. 

ions from competent observers presenting themselves, we can 
say that true Klebs-Loeftler bacilli may occasionally be found in 
apparentlj" normal throats, in what proportion of cases we can- 
not say, as the examination of a sufficient number of cases has 
not been made. The fact remains, however, that they are so 
found and it is quite reasonable that they should be. 

A 








^_ 



/■ 



A. Diajiraaiatic —The Klebs-LoeHler bacillus culiiva.ted on ordinary Loettler"s blood 
scTum, stained with Loettler's methylene blue. 

B. Diagramatic— Klebs-Loetfier bacillus cultivated on plain doK serum, showing 
relative increase in length and increased affinity of the chromatic globules for the stain 
Stained with Klebs' blue and Bismarck brown, 

C Microscopic field of pure culture, cultivated on dog serum and stained with Bis 
niarck brown and Klebs' blue, showing the tive morpliologlcal characteristics 

Individuals' nursing cases of diphtheria have frequently been 
subjected to an examination of their throats and Klebs-Loeftler 
bacilli found. An infectious disease is designated as one which 
arises when a specific pathogenic micro-organism gains admit- 
tance to the body and finding conditions favorable, grows, multi- 
plies and elaborates a chemic poison which produces its charac- 
teristic effects. Therefore it is not at all unreasonable to assume 
that the true Klebs-Loeffler bacillus can, under certain conditions 
present in certain individuals, be found in the throat without 
producing the pathological changes incident to the j^ropagation 
of diphtheria bacilli, the conditions present in the throat not be- 
ing favorable for its propogation and multiplication with subse- 



Ciuiiad Lahoratorij - Deparimeiif. 257 

quent elaboration of toxins. Intact and healthy conditions of 
mucous membranes therefore reduce the susceptability. 

The usual habitat of the Klebs-Loeffler bacillus outside of 
the body is unknown, it has been suggested that it be the organic 
constituents of the superficial soil of the earth. 








-'^r^'^' 



<«K«^- 



a' 



Crdss Section of Child's Trachea. 
Pseudo diphtheritic ruembraiie. at the margin of which are seen many colonies o 
diphtheria bacilli. 

B. Sers-flbriuous exudate between the mucosa and deep surface of membrane. 

C. Mucosa and submucosa, the ciliated column epithelium of which is entirely de- 
stroyed, the underlying glands are apparently normal, centrally situated is seen a con- 
gested blood-vessel. 

I). Cartilage of trachea. 

E. Connective tissue surrounding the cartilage of trachea. 

Pathogenesis: — The diphtheritic toxin induces first a necrosis 
or death of cells with which it comes in contact, particularly the 
superficial epithelium and the leucocytes, the deeper cells of the 
mucosa and of the other parts reached by the toxin may also be 
affected. The second change is hyaline transformation of the 
dead cells or, as Weigert terms it, coagulation necrosis. The 
bacilli excite inflammation with the migration of leucocytes, 
which are destroyed by the toxin and undergo the hyaline 
change. 

The superficial epithelial layers undergo a similar alteration 



Tlie Plexus, 

and what we knowJasCthe false membrane represents an aggre- 
gation of deadjcells^ most of which have undergone the transfor- 
mation into hyaline material. 

D{ferentiation and Diagnosis: — It is certain that without a 
bacteriological examination, all the known clinical methods will 
not allow of a correct diagnosis at an early stage of the disease. 
By clinical methods alone many cases are diagnosed as diphtheria 
which are not, and undoubtedly many cases of mild diphtheria 
are not recognized as such. Martin has analyzed 200 cases diag- 
nosed clinically as diphtheria, 72 showed no Klebs-Loeffler bacilli. 
Among the 200 cases, 43 were non- diphtheritic anginas, 69 diph- 
theritic anginas, 29 non- diphtheritic cases of croup, 59 diphther- 
itic cases of croup. 

The methods employed for the differentiation of micro-organ- 
isms usually depend upon two factors, used either separately or 
combined, both intended to bring out certain morphological 
characteristics which are possessed by no other micro-organism. 

The first is a differentiation by certain staining methods, the 
second, differentiation by certain culture methods. Whichever 
method allows of the most complete differentiation is selected. 
In some cases animal experiments may be required. 

An example of the first is the method of differentiation of the 
tubercle bacillus group which retains its stain when treated by 
mineral acids, while all other bacteria give up their stain. An 
example of the second is the special culture medium for the 
growth of morphological characteristic forms of Klebs-Loeffler 
bacilli. 

F. Robert Zeit a late assistant of Klebs has followed the ex- 
periments of Ernst and Neisser who were successful in using a 
double- stain on the Klebs- Loetfler bacillus. The microscopic 
specimen and diagram before you show the results obtained. 
The ground-substance of the bacillus is yellow, the characteristic 
chromatic globules are blue-black. 

The specimens before you showing the above results were 
kindly loaned to me by Dr. Zeit. The method of staining is as 
follows: 

I. The cover-glass is spread with a thin layer by the cotton 
throat swab with material taken from around the edge of the 
membranes. 

II. Dry in air. 



Clinical Laljoratory Departtnciit. 

III. Fix by passing cover glass, (film up) 3 times through 
flame. 

IV. Stain one minute with Klebs' blue (Methy. blue 5, borax 
5, water 100). 

V. Wash thoroughly with water. 

VI. Counterstain 3 minutes in 1 per cent, watery Bismark 
brown. 

VII. Wash in water, dry and mount in xylol balsam. 

This method is very simple and effective. Zeit has experi- 
mented with various culture media, and has found that the serum 
of dogs proves to be the most satisfactory in that it brings out 
the characteristics of the diphtheria bacillus so as to leave noth- 
ing more for differentiation, even with the simplest staining 
methods. You find a specimen of this kind stained with Klebs' 
blue only before you. The dog serum is sterilzed two hours daily 
for a week at 58° C, then coagulated in slants at 70'^ C, on glucose 
or bouillon is added. The bacilli grown on dog serum are twice 
as long as those found on Loeffler's serum, the ground substance 
is pale blue, the chromatic globules (blue black'. An error in 
diagnosis is impossible with such a specimen. I have side by 
side with it slides of cultures made at the same time and of the 
same age on Loeffter's serum, bouillon, agar, and on the serum 
supplied by the Chicago Board of Health. 

To make a positive diagnosis of Klebs- Loeffler diphtheria 
Zeit has observed the following morphological points, which, if 
present in the direct throat swab smear, will enable us to make a 
diagnosis without culture. 

I. A short bacillus somewhat swollen at the ends, with a 
dot in each thickened end. 

II. A somewhat longer bacillus, with a dot in each end and 
one dot near the center. 

III. A still longer form with a dot in each end and two dots 
close together in the center. 

IV. A short club-shaped form, either staining entirely or 
showing a dot in the thickened end. 

V. Parallel arrangement of bacilli of one or different forms. 



(£)liniGcil Deparhmenb. 

COLLEGE OF PHYSICIANS AND SURGEONS. 

E. A. Gansel. 

Prof. GoodkincVs clinical course on General Diagnosis, al- 
though a few weeks late in beginning on account of his trip 
abroad, is giving to the members of the senior class a splendid 
variety of work. Besides very carefully going over and differ- 
entiating the common and more frequent varieties of aisease, 
Prof. Goodkind also manages to give to the students the benefits 
of many rare or particularly interesting cases which he meets in 
his large hospital practice in other parts of the city. 

This careful selection and presentation of cases certainly 
means a large amount of extra work and time for the diagnosti- 
cian in charge, but it gives an insight into diagnosis which text- 
books alone are utterly unable to convey to the student. 

Amony the many cases of interest presented in this clinic 
during the past month were the following: 
I. Syringomyelia: 

Male. Age 47 years. Ironmoulder. Married. 
Present T7-o?<?>/e.-— Began eleven years ago with a feeling of 
weakness in right arm, followed by weakness in both lower ex- 
tremities. Soon after onset developed sores about his finger 
nails. While working at his trade he accidentally burned him- 
self but suffered no pain whatsoever. His weight at the onset 
of disease was 170 pounds, but has been gaining until now he 
weighs 240 pounds. 

Personal History: — Had a sore on his penis 15 years ago with- 
out the development of any secondary symptoms. Is the father 
of several children. His wife has had no miscarriages. 

P/iysical Examination: — Gait, spastic. Has atrophy of in- 
terossei muscles with prominence of the thenar and hypothenar 
eminences of both hands. Has some atrophy of calf muscles. 
Has a slight tendency to talipes and presents a moderate degree 
of scoliosis. Knee jerk exaggerated and ankle clonus present on 
both sides. Necrotic areas present about finger nails. Painful 
and thermic sensations not recognized, but has retention of tac- 



(Jlinical Department. 261 

tile sensation. Has a slight degree of incontinence of urine but 
no rectal disturbance. Cranial nerves normal. 
Differential Diagnosis. 

1. Amyotrophic Lateral Sclerosis: — This must be considered 
because of the spastic gait, increase of reflexes, peculiar distri- 
bution of atrophy (prominence of thenar and hypothenar emi- 
nences). 

The presence of bladder and sensory disturbance exclude 
this condition. 

2. Transverse Myelitis: — Can be ruled out on account of pe- 
culiar distribution of the atrophy, the character of sensory and 
trophic disturbances and the gradual onset — 11 years' duration. 

3. Multiple Sclerosis: — This can be eliminated because of the 
trinity of symptoms — intention tremor, nystagmus, scanning 
speech. 

The only condition that could produce this traia of symptoms 
is Syringomyelia which is a formation of a cavity in the spinal 
cord with gliosis. 

This patient presents classic symptoms — absence of disturb- 
ance of tactile sensation with loss of thermic and pain sense; the 
lawless distribution of the muscular atrophy; the chronicity of 
the disease; the scoliosis with the beginning localization in the 
cervical region. 

The cavity formation sometimes extends into the medulla 
producing bulbar disturbances. 

Etiology: — Obscure. Supposed to be a congenital defect in 
development. 

Prognosis: — As to life, hopeless but extending over a long 
period. Death usually supervenes from bulbar paralysis, in- 
volvement of respiratory centers or an intercurrent pneumonia 
and in some cases from extensive trophic disturbances. 

II. Multiple Sclerosis: 

Male. Age 35 years. Peddler. Single. 

Present Trouble: — Began suddenly six years ago with partial 
loss of movement (sensation remaining intact) of left lower ex- 
tremity. Patient had been taking a bath and on emerging took 
notice of the above. 

Duration of this condition of left lower extremity 6 months, 
after the expiration of which motor function in leg was perfectly 
restored as the result of treatment. 



262 The Plexus. 

Five years ago he experienced a motor paralysis affecting 
right lower and left upper extremity, sensation remaining intact. 
Simultaneously he lost power of speech which he recovered in 
six months, whereas the paralysis continued one year. He at- 
tributes his peculiar grimaces which appeared with loss of speech 
to an involuntary act and smiles regardless of his feelings. 

Has had repeated apoplectic insults, several epileptoid seiz- 
ures, occasional headache and vertigo. Bowels constipated. 
Appetite good. 

Past History: — Negative. 

Personal History: — Gonorrhea 15 years ago. Denies luetic in- 
fection. 

Family History: — Parents living and well. Father 85 years 
old. Mother 75 years of age. 

Physical Examination: — Reflexes exaggerated particularly on 
left side. Left ankle clonus present. Peculiar grimaces. Dis- 
coloration of disc. No rectal or bladder disturbancee. Slight 
paresis of left facial nerve. Intention tremor. Scanning speech. 
Taste, smell and hearing intact, has never had disturbance of 
them. 

Prognosis: — Unfavorable. Either will become bedridden or 
be carried off by some intercurrent affection. 

EMERGENCY CLINICS. 

Although this special work has been conducted only since 
October, '99, it has already grown to be one of the most popular 
and best attended of our numerous clinics. As students get far- 
ther and farther along in their medical course, and especially 
when they enter upon the''r last year's work in college, they be- 
gin to think more seriously of the facts and principles which they 
must have firmly fixed in mind, as well as at their fingers' ends when 
they have heard their last lecture and seen their last clinic. 

No work can therefore be more interesting or of greater 
value to a senior student than that which teaches him how to deal 
promptly and correctly with an emergency case, hence the popu- 
larity of Prof. Lee's new clinical course at Cook County Hospital. 

Following is a brief synopsis of only a few of the many cases 
presented at this clinic. 

1. Typical case of Pott's fracture. 

'2. Fracture of Surgical neck of humerus. 

3. Male, aged 30 years. Fractured femur 8 months ago, was 



Clinical Departmint. -oo 

improperly reduced, and now presents a marked contraction of 
muscular tissue, with an enormous callous formation. 

Treatment :—Oj)Qn osteotomy. Plaster cast. Supension of 
limb. 

Results: — Primary union and a good useful limb. 

4. Fracture of ivferiov maxilla. 

5. Male, aged 40 years. Anterior Surface of Right Wrist Gut 
to Bone. 

Man fell on plate of glass striking wrist about 4 inches above 
hand. Severed radial and ulnar arteries as well as all tendons 
down to the bone. Hand was somewhat discolored but warm. 

Treatment: Unite all important structures including all ten- 
dons and if possible save hand. 

6. Male aged 34 years. Fracture of Eight Clavicle Inner Third 
and Fracture of Bib. 

7. Boy aged 8 years. Old Fracture Loiver End of Femur and 
In jury of Ankle Joint. 

Foot now very much inverted and there is almost absolute 
ankylosis of ankle joint. This deformity due to not having 
foot dressed at 7-ight angle at time of injury. 

Treatment: — Open arthectomy to produce absolute ankylosis 
of knee joint. 

Prog.: — Bad on account of deformity at ankle. Adhesions 
should be broken up and then plaster cast applied. 

8. Male aged 55 years. Dislocation of Humerus tinder 

Clavicle. 

Treatment: Reduced by Kocher method. Arm dressed with 
hand on opposite shoulder. On 3rd or4th day begin active and 
passive motion, but be careful not to get arm into position 
whichca used the dislocation. 

9. Male, 4i! years. Severe Sprain of Anlde. 
Treatment: Rest at right angle and hot applications. 

10. Male, 73 years of age. Spontaneous Fracture Lower end of 
Femur. 

11. Male, 45 years of age. Subluxation of left Tibia and 
Fibula. Two weeks ago was struck with iron bar below knee 
joint. Could not stand after injury. 

Treatment: Reduce by extension then place limb in semi- 
flexed cast for several weeks, after which should begin passive 
motion. If effusion very marked apply hot dressing before put- 
ting on cast. 



2CA The ri exits. 

12. Male, aged il5 years. Impacted Fracture of Both Ankles. 

13. Female, aged 60 years. Fracture of Neck of Femur. 
Treatmeni: Rotate leg inward and correct the shortening by 

extension. Dress foot at right angle in fracture box. 

14. Male, aged 4w years. Bullet Wound of Skull. Shot him- 
self on Dec. 24th. Bullet entered on right side about 2 inches from 
outer canthus and made its exit on left side over orbital arch. 
Left eye is destroyed, there is sloughing of the cornea. Right 
eye very likely also destroyed. 

Treament: Let alone except cleanse and seal. If shows tem- 
perature and chills or focal symptoms open and drain. 



TREATMENT OF A CASE OF FACIAL NEURALGIA. 

Bernay's {^'Report of a Surgical Clinic") cites a peculiarly ob- 
stinate case of facial neuralgia with treatment. The patient was 
a lady aged fifty years, who showed a good family history and 
whose previous health was also good. The trouble began with a 
sev^ere neuralgiac toothache of her lower right molars, and was 
paroxysmal at first, but after two months became continuous. 
The paroxysms generally occurred in the early morning, and en- 
tailed much acute suffering. The pain was relieved by biting 
strongly upon some firm object, but returned immediately when 
the pressure was removed. The touch of anything cold or hot 
promptly excited a paroxysm. A moderate heat when sustained 
produced the opposite effect. In the effort to afford relief four 
molars were extracted, but without success. The patient stren- 
uously held out against the use of narcotics in any form through- 
out the entire course of the disease. Antikamnia in ten grain 
doses (two five-grain tablets) was found efficient as an obtundant, 
and was relied upon exclusively. Eight weeks after section of 
the nerve, when the report was written, there had been no re- 
turn of her former trouble in any degree. — TJie Medical Neivs, 
[January 13th, 1900.] 



'Alunpni IDeparbmenb. 

"86. Dr. W. F. Follansbee has removed from Chicago to 
Paonia, Colo., on account of his wife's health. 

"93. David W. Roas, So. Frankfort, Mich. 

"93. Gerald Edmunds, Honor, Mich. 

'93. J. F. Adams, Mt. Pleasant, Mich. 

'95. Austin E, Miller is located at Eckert, Colo. 

'97. R. C. Taylor, Lily Lake, 111. 

'97. Rivers Frederick, Coupee, La. 

'97. H. J. Yoist, New Roads, La. 
. "97. E. M. Hamilton, Cairo, W. Va. 

'97. C. L. Treadwell, Kilbourn, Wis. 

'97. G. E. Mayhow, Edgewood, Cal. 

'97. J. J. Brinkerhoff, Minooka, 111. 

'97. A. G. Mizell, Shelbyville, 111. 

'98. E. M. Byers, Belvidere, 111. 

'98. C. F. Whitmer, 502 Pennsylvania Ave., East St. Louis, 
111. 

'99. Married at the home of the bride"s parents, Beloit, Wis., 
Dec. 27, 1899, "95 Dr. W. K. Yeakel and Miss Mabel E. Robinson. 
The doctor is professor of Pathology in the Omaha Medical Col- 
lege, Omaha, whither they have gone to reside. The Plexus 
extends the best wishes of their many friends. 

"99. Dr. E. W- Timm was in the city recently with a case 
for Dr. Steele"s clinic. The doctor has located in Milwaukee and 
is teaching Materia Medica in the Milwaukee Medical College. 

Committee on arrangements for alumni meeting Dr. L. J. 
Mitchell, Dr. W. A. Evans and E. A. Gansell, '00. 

The graduates of "00 are considered members of the Alumni 
Association. 

Dr. E. R. Holmes, "87, who was erroneously reported dead in 
one of the back numbers of the Plexus is located at Ayr, Neb. 

Dr. Theodore B. Sachs, '95, was married on Thursday, Jan. 
4, to Miss Lena Louise Wilson, Chicago. 



266 The Plexus. 

To The Alumni: — 

For reasons approved by the executive committee I have re 
signed your secretaryship. 

I want to thank you for the honors of my election. But, I 
want to thank you very much more for the support that you have 
given me. I have had some kind of communication with more 
than one half of all of the graduates. This jDromises very well. 
It does not require a very far look ahead for one to see that the 
material interests of the Alumni lie in the school and those of the 
school in its Alumni. 

The association is in good condition. My successor elected 
by the executive committee, is Dr. Theodore Tieken. To the 
more recent attendants at the school Dr. Tieken requires no in- 
troduction. The older graduates will not be disappointed in him. 

Communications should be addressed to Dr. Theodore Tieken 
Cook County Hospital, Chicago, 111. 

Very truly yours, 

Wm. Evans, "99. 



DR. ALBERT EDWARD HOADLEY. 

Dr. Albert Edward Hoadley, professor of orthopedics and 
surgical diseases of the joints, in the College of Physicians and 
Surgeons and in the Chicago Policlinic, died at his home on 
January 16. He was born at Chenango Forks, N. Y., in 1847, 
and was graduated from the Chicago Medical College in 1872. 
He immediatelj'' commenced the practice of medicine in Chicago, 
where he remained until his death. He was the author of a 
number of surgical papers and a member of several medical 
societies. The College of Physicians and Surgeons lose a very 
efficient and popular member of its faculty in the death of 
Dr. Hoadley. 



LIBRARY NOTES. 
Grace W. Bryant, Librarian. 

It' has been our custom to give a few library statistics at the 
beginning of each year, in order that the growth of the Library 
may be noted. The Library now numbers 3,31(3 bound volumes, 
400 unbound volumes, about 5,000 pamphlets, besides hundreds 
of unbound journals. During the last two years over 1,200 vol- 
umes have been added. Additions for the year 1899 are as follow: 

Books, 650; pamphlets, 1,000; journals, 5,000. 

By our system of exchange, hundreds of duplicate journals 
have been exchanged for ones needed in the Library, and by this 
means many files of our journals have been completed. 

The average daily attendance has been 91. 

The Library is indebted to Dr. Bayard Holmes for a very 
important gift in the shape of six volumes of the Index Medicus. 
This index is invaluable to every medical library, especially to 
one that does as much reference worlv as ours. We now have 
eight complete volumes out of the twenty-one. Can any one 
give us any of the following volumes: 1-10, 17, ^8. 

Dr. Brumbach has given to the Library J. A. Jeancon's val- 
uable atlas on Diseases of the Sexual Organs, and also a large 
number of journals. 

We have received several bundles of journals and the " Comp- 
tes Rendus du 12th Congris International de medecine,"' Moscow, 
1897, from unknown donors. To these friends we extend our 
thanks. 

The following articles from the pens of the Faculty have 
been noted in the journals: 

Dr. W. T. Eckley — Practical anatomy of the ankle, with 
reference to talipes. Chicago Clinic Dec. 9, 1899. p. 480-84. 

Dr. Bayard Holmes — Progress of medical education — a sug- 
gestion for a better arrangement of the medical curriculum. 
Jour. A. M. A., Dec. 23, 1899. p. 1569-71. 

Dr. G. F. Lydston — Remarks on supra-pubic lithotomy. 
Tex. Med. •Jour. Dec. 1899. p. 308-13. 

Dr. H. P. Newman — Extirpation of the uterus, its appen- 



268 Lihrarg JS'ofes. 

dages. tumors, etc., without ligation or retention. Jour. A. M. A., 

Dec. 9. 1899. p. 1457-61. 

NEW BOOKS. 

Bard, Sam'l. —Midwifery. Ed. 4, 1817. Chic. Homeo. Med. 
College, donor. 

Meyhoffer, John— Chronic diseases of organs of respiration, 
1871. Chic. Homeo. Med. College, donor. 

N. Y. State Eclectic Med. Soc. Transactions. 2 v,1867, 1874. 
Chic. Homeo. Med. College, donor. 

OUR ANNUAL SOCIAL AFFAIR. 

The Athletic Association of the College of Physicians and 
Surgeons has in past years made such a pleasing effect on the 
social life of the student body on the occasion of the yearly recep- 
tion and dance that the event is now considered the particularly 
bright spot in the horizon of the student who strives to cultivate 
the social instinct. Aside from the Glee Club concert, which, in 
itself, has been an extremely enjoyable affair; the student body 
has no other social gaiety which it holds in common. Many 
therefore, have been the inquiries of late concerning the time 
chosen for the dance this year. 

On Thursday evening, Feb. 8, the Athletic Association will 
entertain the faculty, students and friends of the College of 
Physicians and Surgeons, in honor of the foot ball team at 
Beek's Hall, Warren Ave., between Lincoln and Honore Streets. 
From the hours of eight-thirty until ten the reception will be 
held, followed by a dance program of eighteen numbers. The 
quartet from the College Glee Club has very kindly consented to 
assist in entertaining during the reception hours and from what 
has been learned concerning their very excellent singing, they 
will add very materially to the enjoyment of the evening. 
Krell's orchestra will also furnish specially selected overtures 
for the music loving, during these hours, and later will render 
lighter melodies for the benefit of the dances. The committee in 
charge of the arrangements are W. A. Domer, B. C. Corbus and 
G. G. Dowdall. Let the midnight oil stay unburned upon your 
study table and with apologies to Byron, 

May there be the sound of revelry by night 

For P. (S: S. will have gathered then 
Her beauty and her chivalry, and bright 
May shine the lights o'er fair women 

[and medical students]. 



SENIOR NOTES. 

Anyone who will inform this department as to the most re- 
liable make, and the manner of procuring a coat-of-mail will be^ 
rewarded with one stogie and three beers. Said armor must be 
in prime condition and considerations reasonable. 

The blue pencil forbids our publishing conundrums of any 
sort. 

Some fertile brain suggests that the Senior class discard 
ponies and ride the rest of the way in automobiles. 

A very interesting article on "Livijue'" appears in the January 
number of the Chineese Medical Gist from the pen of Dr. Ling. The 
article is an able one and fully up to the standard of the distin- 
guished author. The rest of the foreign element will please take 
note. 

Chicago University does not stand alone in her attempts at 
reform si^elling, as the results of a recent examinati6n in medi- 
cine attest. Of course the new method at first will seem a little 
strange, but soon will grow familiar, and all will be glad that 
medical spelling is placed on a phonetic basis. 

Ask North his opinion of radiator heat as an antiseptic. 

Mr. Winchell was present. 

Heath's timely act of tying up the whiskers was doubly com- 
mendable. It may have presented a wide spread infection. With- 
out doubt it did protect the tender growths from the bitter blasts 
and jealous glances of a cold, cold world. That bold blush, how- 
ever, almost withered them. 

We are "dead" sure of the anatomy of the large white kidney. 

Birkelund hands us the following prescription. It is genuine, 
and actually in use. 

Chinese prescription for opium poisoning: 

2 couples of salted lizards, ll male and 11 female 
i 5 of Corea ginseng root 

1 5 walnuts 

i o lotus leaves 

i 5 tail of rattlesnake 

2 o black dates 

J 5 elm-tree bark 
i 5 devil-fish claw 



270 



The Plexus. 



i 5 hartshorn 

\ 5 birds" claws 

\ 5 dried ginger 

3 5 old coffin nails 
The whole to be mixed with 2 quarts of water, and boiled down 
to one-half the quantity. Then let the patient drink the mix- 
ture as quickly as possible. 

The only pretensions we make to poetic abilities is a "poetic 
license'" to lie when asked "who put it in."" The following was 
contributed: 

Bremken took 
Paper ball, 
Smeared ink 
Over all 

Threw at Bloeh. 
xMax Bloch. 

Max Bloeh 

Got up 

Hit Just, 

Unjust, 

It wasn't Just, 

Poor Just. 

Just think, 
.Just went out, 
While with ink 
All about. 
Bloch was sore. 
Sore Bloch. 



JUNIOR NOTES. 



Dr. Davis informed the class recently that he was not para- 
lyzed. We do not know whether he meant to infer that we were, 
or that he was not on that particular occasion. 

What is the differential diagnosis between diphtheria and 
whooping cough? Ask Dr. Riese alias Dr. Domer. 

Tilmont particij^ated in a marriage ceremony quite recently, 
but as to what extent we have not been able to determine. 

Willy Fong will come in some of these days with his head 
shaved. 

Dr. Boss received a nice pair of patent leather shoes for a 
Christmas present, but they came rather late. He appreciates 
same however as he was almost out. 



Junior Notes. 271 

From the evidence at hand we must construe that the faculty 
have had a "rough house"' as two of its esteemed members had 
each one of their members broken. We trust that their conval- 
escence will terminate in a rapid recovery and that they will soon 
be with us again. 

In our recent election the class made very good selections and 
placed two of its best students in honorable positions. One of the 
offices filled was class poet and after a very heated election Mr. 
Humbach was selected. The other office was that of class historian 
and the class showed its good sense by placing Mr. Jordan in the 
office and then keeping him there. The record of declinations on 
this occasion was smashed, probably owing to the large amount 
of work which is involved in each of these positions. 

Kaeser must have been a little bit confused when he said that 
transverse colon was absent in about 50 per cent, of cases. 

Heintz has made the marvelous discovery that the peritoneum 
runs up and attaches itself to the heart and follows up the ceso- 
phagus. 



SOPHOMORE NOTES. 

THE DOG'S INGRATITUDE, OR, BEEBE'S FIRST CASE. 

I cannot let this dog remain 

Out in this icy night, 
Thus little Beebe did explain, 

With all his main and might. 

The landlady with sourish mien 

The stray cur called within — 
Suspicion in her eye was seen 

As if s/ic'fZ done a sin. 

But Beebe's heart was light and free 

From this world's downs and ups, 
'Till he was called next morn to see 

Six whining little pups. 

Then was that woman sore perplexed 

Her soul was filled with ire, 
Then from the house, that woman vexed, 

Both man and dogs did tire. 

Sp — k-r cannot see why a senior should monopolize the 
glances of the brown eyed German lassie of the Soph, class. And 



Ttl The Fle.nts. 

strange to say, that is just wliat a senior lass thinks also. Will 
some one kindly volunteer to bring the parties of the first and 
the last parts together for mutual commiseration? 

The girls want to know whether our brother Hahn is as ex- 
pert in paring potatoes and washing dishes as is reported — Some- 
body inform them. 

what's in a name. 

"A-r-n: If I am so great when a boy, what will I be when 
a man"? 

A-n-w: "The worst fault that you have is to be in love"'. 

Br-wn: "A chip of the old block". 

B-C-: ''The microscope, the blanked microscope has brought 
me many a woe." 

C-ea-y: "He digs for knowledge like a mole." 

D-y: "She never told her love." 

Fr — m-n: "Where none are beaux, 'tis vain to be a belle." 

G-rr-tt (Sophag.) "I am. no orator as Brutus is." 

M-r-s: "Teach not thy lips such scorn; for it was made for 
Kissing, lady, not for such contempt." 

Mil — r: "A concatenation of romances." 

Sab-n: "Few and short were the prayers he said." 



FRESHMEN NOTES. 

Alward is still sick (?) 

Wilson forgot his usual question in Materia Medica one day 
last Aveek. It will probably not happen again. 

Professor — What is a synonym for the ilio-ischial line? 

Student — Waddle's line. 

Is it true that McGann is taking up obstetrics seriously? 

Mr. O. G. can no longer conceal his identity. Now that he 
has been found he is discovered. 

It is safe to predict more attention on the part of the D. J's. 
to the matter of drugs in view of a repetition of the failure to de- 
fine Materia Medica. It can only be accounted for on the ground 
of stage fright and the victims are deserving of sympathy. Don't 



Freshmen Notes. 273 

weaken boys, even if you feel a little shaky. Some of the older 
ones will tell you that a good bluff will sometimes earn a good 
mark and one of the cardinal points of a successful physician's 
make up is the ability to impress others with apparent knowledge 
of anything and everything. 

Joyce says he has turned over a new leaf and will keep still 
hereafter during roll call. 

Dr. — "Mr. Dodds. What are honeys?" Dodds, (after con- 
siderable blushing), "small coons.'" 

McGhann's idea of developing bones by the nail process seems 
to be a little hazy. 

Subscriptions due! Gluteus Minimus. 

Have you noticed how cheerful J. W. Wilson has been of late? 
He visited the woman's medical so they say. 

Three of Lipman's lady friends visited anatomy the other 
day. How did they enjoy it Lipman? 



NEWS ITEMS. 

Dr W. E. Coates read a paper on Parasitic Origin of Tumors 
before the Chicago Pathological Society, Monday evening, 
January 9. 

Dr. E. A. Fischkin spent his Christmas vacation in New 
York. 

Dr. J. B. Eagleson of Seattle, Wash., read a very able article 
before the Idaho State Medical Society on "When shall we 
operate for Hernia":;'" Dr. Eagleson gave the Plexus readers a 
very interesting article on Large Uterine Fibroid accompanied 
by Pregnancy, in the August number. 

COMPETITION FOR THE AMERICAN MEDICAL ASSOCIATION MEDAL. 

At the meeting of the American Medical Association, held 
June 4, 1897, it was resolved to restore the former policy of the 
Association in favor of offering annually a gold medal for meri- 
torious scientific work. The committee for this year, consisting 
of Drs. George M. Gould, of Philadelphia, E. Fletcher Ingals, of 
Chicago and T. W. Huntington, of Sacramento, Cal., desires to 
direct attention to ihe following rules governing the competition: 

1. The medal shall contain the seal of the United States or 
a seal of the Association, to be hereafter designed, on one side 



274 The Plexus. 

and an Esculapian staff on the other, together with the name of 
the recipient of the medal and suitable inscriptions. 

'2. The commercial value of the medal shall be l|lOO. 

3. A standing committee on prize medals, consisting of three 
members of the Association, shall be elected by the Business 
Committee as follows: One for one year, one for two years and 
one for three years, and thereafter one to be elected yearly to 
hold office until in either case his successor has been duly elected. 
In no case shall a member of the Business Committee hold a place 
on the Committee on Prize Medals. 

4. The competing essays shall be typewritten or printed 
and shall bear no mark revealing their authorship; but instead 
of the name of the author, there shall appear on each essay a 
motto, and accompanying each essay shall be a sealed envelope 
containing the name of the author and bearing on its outer sur- 
face the motto of identification. No envelope is to be opened 
by the committee until a decision has been reached as to the most 
deserving essay, and the other essays have been returned to their 
respective owners. The committee shall have authority to reject 
and return all essays in case none have been found worthy of the 
Association medal. Competing essays must be in the hands of 
the committee not later than March 1, 1900. For further infor- 
mation address any member thereof. 




VV T. EC K LILY, M. 1). 
Professor of Ariiitomy CollHg'e of Physicians iiiul Surgeons. 
•Ji)ic;igo Clinitiil Scliool and Nortli western Universiiy 
Deniiil Colleiie. 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT Op THE 

UNIVERSITY OF ILLINOIS, 

VOL. V. FEBRUARY 20th, 1900. ^ NO. 10. 



SOME ANATOMY FOR SENIOR STUDENTS TO 

REMEMBER. 

W. T. ECKLEY, M. D. 

Professor of Anatomy, College of Physicians and Surgeons, Chicago. 

I. The pubic (3rest is limited by the pubic spine and angle. 
The pyramidalis, rectus and conjoined tendon occupy the crest. 

II. The crest of the ilium is limited by the anterior and 
posterior superior spines; it has three lips — outer, middle and 
inner — occupied for the most part by the external oblique (i), 
internal oblique (f) and transversalis (f) muscles respectively. 

III. The linea alba is limited by the symphysis pubis and 
ensiform cartilage of the sternum. It is at the junction of the 
aponeurotic parts of the three planiform abdominal muscles. It 
is analogous to the strenum, and near the center is the umbilicus. 
No blood vessels can be seen in the linea alba, and for this rea- 
son and owing to its location being favorable for interrogating 
the abdominal contents, the incision in many abdominal opera- 
tions is made here. Laterally, the linea alba is limited by the 
two recti muscles. Below the umbilicus, the muscles are separ- 
ated by a mere fibrous septum, hence the difficulty of making an 
incision without cutting some muscular fibres of the rectus mus- 
cles. Above the umbilicus, the linea alba is wider, owing to the 
slight divergence of the recti muscles. 

IV. The umbilicus transmits vessels to and fiom the pla- 
centa during intra-uterine life. The vessels concerned are right 



276 Tlie Plexus. 

and left lympogastric arteries, two in number, and one umbilical 
vein. The arteries arise from the internal iliac. They carry blood 
laden with C Oo to'the organ of respiration for the foetus, the pla- 
centa, where, according to the physical law governing the diffusion 
of gases, C Oo is dumped and O taken on. The umbilical vein re- 
turns the oxygnated blood to the general system via (1) the liver 
and {^) the ascending vena cava. The senior should remember 
the make up of the umbilical cord: two hypogastric arteries, one 
umbilical vein, held corporately in a twisted, knotted mass by 
mucous connective tissue called jelly of Wharton. The foregoing 
is the ante-natal importance of the umbilical region. 

Post-natal importance of ■umbilical region: In practice, how to 
cut and properly ligate and aseptically dress the cord, may cause 
you to review your obstetric notes. I once knew a very inferior 
medical man who built up a superior practice on account of his 
immaculate toilette of ^the stump, and of course the bad results 
that never followed his obstetric practice. 

Remains of umbilical vessels in the adult: In the adult, the 
lungs aerate the blood; in the foetus, the placenta, as observed 
above, does this work. The lungs are then analogous to the pla- 
centa, because the two organs are functionally identical; they are 
not homologous, however, because they are structurally dissimi- 
lar. The pulmonary artei;ies and veins are both analogous and 
homologous to the hypogastric arteries and umbilical vein be- 
cause of the double community of both function and structure. 
The functional activity of the hypogastric arteries ceases at 
birth. Suspension of function as fluid-bearing conduits, entails 
loss of those specificqualities that characterize arteries and veins. 
Endothelium, nerve, vessel and contractility are soon no more; a 
mass of connective tissue only, remains to tell the morphological 
tale of a most interesting metamorphosis. In the adult, you 
may see on the cadaver the remains of the hypogastric arteries 
as two pronounced cords emanating from the umbilicus and 
slightly diverging from each other, crossing the pelvic brim in 
front and forming the plica hypogastrica. This fold separates 
the internal from the middle inguinal fossa, either of which 
may allow a direct inguinal hernia. The obliterated umbilical 
vein obtains as the round ligament of the liver; it may remain 
open aud has been known to form a fistulous tract for small gall- 
stones. Surgical interest centers about the umbilical region 
since hernia in both child and adult may occur here. 



Anatomy 277 

Hernial fossae: Specimen No. 407 in the museum of normal 
anatomy shows (1) the external inguinal fossa just external to 
the deep epigastric artery. This fossa corresponds to the inter- 
nal abdominal ring and marks, (a) the place where the spermatic 
cord is made up and (b) the inner end of the inguinal canal; (2) 
the middle inguinal fossa, limited externally by the deep epigas- 
tric artery and internally by the remains of the hypogastric 
artery; (3) the internal inguinal fossa, limited externally by the 
hypogastric remnant and internally by the urachus. As already 
stated, these two latter fossae correspond to the direct variety of 
inguinal hernia. (4) The femoral fossa is internal to the femoral 
vein below the crural arch and corresponds to the femoral ring, 
the beginning of the femoral canal, the anatomical weak point 
of the abdominal walls concerned in femoral hernia. 

V. Poupart's ligament, also known as the crural arch, is the 
lower border of the aponeurosis of the external oblique muscle of 
the abdomen. It is attached to the pubic spine internally and to 
the anterior superior iliac spine externally. The fascia lata is 
attached to the lower border; the internal oblique and trans- 
versalis muscles are attached to its outer half. This ligament 
forms the floor of the inguinal canal and supports the spermatic 
cord and round ligament of the uterus. The spermatic cord 
emerging from the external abdominal ring between the pillars 
of the ring, crosses the inner end of the crural arch. Under the 
crual arch and passing from the abdominal cavity to the thigh, 
may be remembered the femoral sheaths formed by the union of 
the iliac and transversalis faciae. The sheath contains the com- 
mon femoral artery and the accompaning vein and the femoral 
canal. The anterior crural or femoral nerve is not in the femoral 
sheath but one-half an inch external thereto in a groove between 
the iliacus and the major psoas muscles. The external cutaneous 
nerve passes under the crural arch near the anterior superior il- 
iac spine. Morphologically, we must thiuk of this latter cutan- 
eous nerve as a dismembered, divorced or aberent branch of the 
anterior crural nerve since the muscles underlying its fascial 
and cutaneous distribution are supplied by the anterior crural 
nerve. To refresh your memory on the region about the crural 
arch, examine specimens 127 in the museum of normal anatomy. 

VI. The dee}} epigastric artery and HesselhacW s triangle. This 
artery is a branch of the external iliac. It enters the sheath of 
the rectus muscle at the semilunar fold of Douglas and anasta- 



278 Tlie Plexvs. 

moses with a terminal branch of the internal mammary artery. 
This artery covered by peritoneum, forms the. plica epigastrica: 
oblique inguinal descends external to it, direct internal thereto. 
A triangular space, through which direct inguinal hernia passes, 
bounded below by Poupart's ligament, externally by the deep ep- 
igastric artery, and internally by the rectus, is called Hessel- 
bach's triangle. 

VII. The inguinal canal represents the course pursued by 
the testicle in its descent into the scrotum. It begins just at the 
outer side of the deep epigastric artery at the internal abdominal 
ring in the transversalis fascia and ends near the pubic spine at 
the external abdominal ring in the aponeurosis of the external 
oblique muscle. The canal in the adult is about one and one- half 
inches in length. The floor of the canal is the crural arch. The 
roof is formed by the fibres of the internal oblique and transver- 
salis muscles, which leaving their attachment to the outer half 
of the crural arch, pass in an archiform manner to be inserted by 
a conjoined tendon into the public crest. The outer wall of the 
canal is skin, superficial fascia and the aponeurosis of the exter- 
nal oblique muscle. The internal wall is the transversalis fascia 
and conjoined tendon in part. The canal contains the spermatic 
cord in the male and the round ligament in the female. 

VIII. The spermatic cord is made up at the internal abdom- 
inal ring by the meeting of the spermatic vessels and the vas 
deferens, the excretory duct of the testicle. The spermatic ar- 
tery is a branch of the abdominal aorta, being given off below 
the renal artery. It supplies the testicle, anastamosing with the 
artery of the vas. In front of the cord, lies the ilio-inguinal; be- 
hind the same, the genito-crural nerve. The latter nerves sup- 
plies the crem aster muscle. 

IX. The testicle, its coverings and descent: The testicle before 
birth, occupies a position behind the peritoneum and below the 
kidney. About the time of birth, the testicle descends to the 
scrotum. Its descent is facilitated by the gubernaculum. Each 
of the following structures of the abdominal walls recedes before 
the descending testicle, and collectively these receding parts of 
the abdominal walls, are called the coverings of the testicle, and 
each member of the coverings receives a special name: — 

a. The peritoneum recedes forming the tunica vaginalis 
testis. 



Anatomy. 2(9 

b. The receding part of the transversalis fascia is called the 
infundibulum. 

c. The receding part of the arched fibres of the internal 
oblique is called the cremaster muscle. 

d. The receding part of the aponeurosis of the external 
oblique is called the intercolumnar fascia. 

e.. The receding part of the superficial fascia and skin is 
called the scrotum. 

It may be well to remark that the transversalis muscle re- 
cedes, but the receding part is ignored by all authors on anatomy 
and surgery. The case of Wolf, who died in Cook County hos- 
pital last August of an unusually large inguinal hernia and was 
reported in the '-Clinical Review" by Dr. Davidson and myself, 
showed very clearlj^ the part of the covering derived from the 
transversalis fascia. 

X. McBarveifs point: I Draw a line from the anterior super- 
ior spine of the ilium to the umbilicus and the point will be about 
two inches from the initial end of the line. Tenderness in this 
region on deep pressure is supposed to be diagnostic of appendi- 
citis. You are to remember that the caecum with the appendix 
is variable in location. In cases of incomplete rotation of the 
gut, the large intestine may remain on the left side of the verte- 
bral column. Very often the caecum is quite near the liver and 
not infrequently the appendix is far below the pelvic brim. You 
should not deny a patient the benefit of an operation because on 
deep pressure you fail to elicit pain in McBurney's point. 



A CLINICAL REPORT. 

(a). Transverse myelitis. 

(b). Hemorrhage into the cervical cord. 

By Arthur W. Dunning, M. D. 

The following cases are reported, uot because of anything 
particularly unique in them, but the types are of sufficient infre- 
quency to render each case of more than passing interest. 

(a). O. B. age twenty years, colored; native of Indiana, un- 
married; by occupation janitor of a large building. Father died 
suddenly; mother is living, but suffering from heart disease. 
The family history otherwise is negative. 

Patient had pleurisy three years ago, and was very sick. A 
little more +nan a year ago had gonorrhoea which was not com- 
pletely cured. There is no distinct history of syphilis obtainable. 
However, a habit of promiscuous and excessive sexual indulgence 
is frankly admitted. 

Patient came under my observation Dec. 26th, 1898. Five 
weeks previously began having pain in the back and neuralgia 
in the head. Two weeks later the feet began "tangling them- 
selves up and clinging to the ground," as he said, when attempt- 
ing to walk, and there was tingling and numbness. In other 
words, both sensory and motor involvement of the lower extrem- 
ities. This grew rapidly worse, until at the time of my first ex- 
amination he could not walk at all. There was obstinate consti- 
pation and partial retention of urine for a short time. He com- 
plained of a moderate amount of pain only at intervals and it was 
confined practically to the mid thoracic region. On physical ex- 
amination the knee jerks were both increased and spastic in 
character, the superficial reflexes in the trunk region being 
somewhat decreased. There was a slight ankle clonus. There 
was very little jjower remaining in the legs and the muscles 
were becoming soft and flabby, the skin dry, harsh and scaly, but 
there were no bad pains at any time. There was marked anaes- 
thesia of both lower extremities and of the trunk to the nipple 
line, but the tactile sense was retained and there was marked 
girdle sensation at this line. Above this point sensation, nutri- 




ARTHUR W. DUNNING, M. D. 

C'linicul Instructor in Neurolosy University of ^Minnesota, 

Assfciate Neurologist St. Paul Free Dispensary. 



A Clinical Report. 281 

tion and power were normal. The upper extremities were not 
involved in the slightest degree in the morbid procfess. 

At this time the bladder and bowel symptoms had disap- 
peared and there was no involvement of the sphincters. 

Diagnosis was made of transverse myelitis at the level of the 
fifth dorsal segment. The subsequent course of the' disease was 
a joeriod of some three weeks practically unchanged, after which 
there was gradual but steady improvement. 

The treatment adopted was complete rest in bed, forced nu- 
trition with the use of mild tonics and reconstructives generally. 
After some weeks, when improvement had gone so far that the 
patient could come to the office in a wheel chair, central galvan- 
ization and general faredization was applied. Under this course 
improvement was continuous until July 20th when he was able 
to walk with the aid of two canes; the muscles were much firmer 
and general nutrition had improved in a marked degree. At this 
point, however, he was suddenly taken with pneumonia and died 
ten days later. 

Much to my regret 1 was unable to obtain permission for an 
autopsy, therefore, what would have proved the most valuable 
portion of this report, namely, the pathological findings, I am 
unable to give you. 

To my mind the most interesting feature in this case is the 
probable etiology. The patient glibly, and with the firm belief 
that it was the cause of his trouble, related the fact that immedi- 
ately prior to its onset he had been engaged for two days in work 
which necessitated his being thoroughly wet and cold all day. 

This, until recently, would have been deemed sufficient cause, 
for it is a very common history of just this class of cases; but in 
the light of our present knowledge of pathology, and the fact 
that such lesions do not occur as a simple inflammation due to 
cold alone, there must have been some pre-existing source of in- 
fection in the body. This, I believe, to have been the gonor- 
rhoea which served as the source of infection, while the exposure 
to wet and cold for a protracted period served simply to favor 
the introduction and development of the infection in the cord. 

(b). HEMORRHAGE INTO THE CERVICAL CORD. 

This case came under observation at the St. Paul Free Dis- 
pensary on Nov. 23rd, 1899, and gave the following history; 
Name, John E.; age48yrs. ; nativity Pennsylvania; occupation 



282 ?^c Plexus. 

Iron Puddler (and for three months just passed) farm hand; so- 
cial condition, widower with three children. 

The family history is negative, personal history also nega- 
tive as to any evidence of chronic or constitutional disease. Had 
Typhoid fever at age 2d. No history or other evidence of syphi- 
lis or of tuberculosis. Has had several attacks of sciatica, but 
these were probably induced by his occupation- Habits fairly 
good. Has always drank some, but never to excess. 

History of present trouble: On Nov. 4th, 1899, (nine- 
teen days prior to coming under observation) while driving from 
town to the farm with a load of shingles he fell to the ground, a 
distance of about seven feet, striking on the hard road on the 
back of neck and shoulders. The head was bent forward by the 
full force of the fall and was not hurt at all- There was no loss 
of consciousness, but immediate and complete paralysis of all 
four extremities so that he was unable to move from the position 
in which he fell. In fact, he claims that his body remained in 
the inverted upright position (probably leaning against some ob- 
ject) until some one came to his assistance. As near as can be 
learned from his recollection of his condition there was for a few 
days following the accident complete and absolute loss of power 
in all four extremities. Tactile sense was but little impaired. 
Peripheral sense of pain somewhat dulled, but Aot abolished. 
There was some pain throughout the extremities and the trunk, 
but more severe in the arms, i. e. of segmental distribution. 
There was partial retention of urine for a short time only. The 
bowels were constipated at first, but soon became normal. 

Present condition on nov. 23rd, 1899. (The time of my 
first examination). Patient is short and of sturdy build; is 5 ft. 
4 in. in height and weighs 145 lbs. Is well nourished. 

Is able to walk a little; the gait is even and natural, but weak. 
There is a slight power of movement in the fingers of the right 
hand; and also in the extensors of the forearm. The left arm 
and hand are also completely paralyzed, and the hand edematous. 
The back and shoulder muscles are rigid; patient cannot turn the 
head without rotating the body. Sensibility is normal every- 
where. There is still some pain in the extremities. The knee 
reflex is exaggerated on both sides, particularly the left, and 
there is slight ankle clonus on the left side, none on the right. 

The course since the above date to that of the present writ- 



A Clinical Report. 285 

ing, (Feb. 1st, 1900) has been a rapid and steady improvement, 
until now the legs have regained practically their normal power. 
The right hand has regained nearly its normal power and dex- 
terity, and the left hand has regained a good deal of its power 
though it is still somewhat edematous. The writer believes that 
in view of the rapid improvement thus far, a complete recovery 
may be confidently anticipated in this case with possibly a slight 
permanent impairment of the left hand. 

The diagnosis made at the time of first examination was a 
hemorrhage into the substance of the cord, probably at about the 
level of the fifth cervical segment. It would, of course, have 
been impossible at the time of the accident to distinguish be- 
tween this condition and fracture with bone pressure on the cord 
or a meningeal hemorrhage with pressure; but the rapid and al- 
most immediate improvement would exclude the former, while 
the absence of pain and tenderness in the back and the compara- 
tively slight sensory disturbances, (less certainly) rule out the 
latter. 

No credit, whatever, is claimed for treatment, as the only re- 
medial measure adopted was electrical stimulation of the mus- 
cles involved to keep up their nutrition. Otherwise, it was 
wholly upon the expectant plan. 

583 Eudicott Arcade. St. Paul, Minu. 



NOTE ON THE CRANIAL NERVES. 
L. Harrison Mettler, A. M., M. D. 

Professor of Physiology. College of Physicians and Surgeons, Chicago. 

ZIZ. It is an axiomatic truth that ignorance complicates and knowl- 
edge simplifies. This is shown very clearly in the development 
of the mechanical arts. The earliest steam engines were verita- 
ble Chinese puzzles in comparison with the modern steam engines 
of the same type. In all of his synthetic and analytic processes 
man works from the intricate down to the elementary and not, as 
would be expected a priori, from the elementary up to the intri- 
cate. Nowhere is this singular fact more observable than in the 
solution of physiological phenomena. It is manifested in every 
department of physiology;. it is most noticeable in the physiology 
of the nervous system. 

The cranial nerves have for a long time been the bete noire of 
medical students. The memorizing of their names, their courses 
and their functions has caused the burning of much midnight oil. 
For this the ignorance of the older anatomists, with their im- 
perfect methods of investigation and classification is largely re- 
sponsible. With the aid of embryology and comparative anatomy, 
we are today not only discovering that the cranial nerves are less 
complicated than they seem to be, but we are provoking amaze- 
ment at the arbitrary way in which the older anatomists named 
and classified them. In many instances they put the cart before 
the horse and as a consequence we have been obliged to study the 
results of their queer science rather than the actual condition of 
things. 

To show how vre are facing 'right about in many of our ideas 
let me cite a few examples. Heretofore it has been taught that 
the spinal nerves constituted the fundamental nerve type, and that 
the cranial nerves were simply -modified spinal nerves. The head 
has been regarded as a modification or readaptation of certain 
vertebrae at the anterior end of the spinal column. Now we are 
beginning to believe that the head is older than the trunk and 
that the cranial nerves are-more ancient than the spinal nerves. 
The vertebrate animal, which, as Owen says, is but a "clothed 
sum of segments," is made up of a- number of segmental divisions, 



Cranial Xerves. 285 

the more anterior of which are the more ancient and have ulti- 
mately become shaped into the so called head. The nerve struc- 
tures associated with these anterior head segments are necessarily 
therefore older than the posterior or spinal nerve structures. 
Certain primitive elements that are still retained in the cranial 
nerves or become shifted about in the evolution of the head have- 
disappeared from the trunk nerves and so given the latter an 
apparently simpler appearance than the former. 

Again, it used to be taught that the optic, auditory and olfac- 
tory were true nerves in the same sense as the pneumogastic. 
Now we know that the optic, auditory and olfactory tracts are 
cerebral structures and strictly speaking are not nerves at all. 
They are to be classified with the intracerebral tracts. This 
leaves the motoroculi as the real first cranial nerve. 

Is there any principle in accordance with which an intelli- 
gent classification of the cranial nerves may be made"? Yes, 
there is phylogenetically. If the evolution of the higher forms 
of life be traced downward through the reptiles and amphibians, 
there will be unfolded a panoramic picture of the cranial nerves, 
together with all the cerebrospinal nerves, that for simplicity 
cannot be surpassed. It will be seen that they are made up of 
lateral extensions from certain central deposits of gray matter 
in each of the respective segments of the organism. This seg- 
mental origin of the nerves is obvious enough in the arrangement 
of the spinal nerves, as each vertebral section of the spinal cord 
is clearly seen to have corresponding lateral extensions, motor 
and sensory, known as the anterior and posterior roots of each 
side. When studied phylogenetically the cranial nerves are dis- 
covered in the same way to be mere processes extending from 
certain segments and inclosing motor and sensory elements. The 
question to be solved is why this primitive, simple arrangement 
has become so broken up among the cranial nerves as to give to 
them their present extremely complicated ajopearance. To 
answer this question a number of things must be briefly con- 
sidered. 

Of all parts of the body the head, and especially the nervous 
apparatus of the head, is the most susceptible to the influence of 
evolutionary forces. The skull and especially the brain is 
marvellously submissive to those influences which act through 
heredity and environment to mold and transform them to meet 
the exigencies of a higher development. The head being a part 



286 The Plexus. 

of the general segmental structure of the animal, though the 
most ancient part, necessarily contains the same structural ele- 
ments as all the other segments of the body. Each segment con- 
tains three primitive elements as shown in the nervous appara- 
tus. There is the sensory element (cutaneous), the motor ele- 
ment (somatic), and the visceral (branchial) element. This last 
element is appendicular and is, so to speak, a mere attachment, 
a something added on for a special purpose. Thus we behold 
in the primitive archetypal form of animal, so frankly displayed 
in some of the lower species, a central deposit of gray matter 
(nucleus) in each segment, a process extending from this nucleus 
outward laterally on either side to the cutaneous surface for the 
reception of sensory impressions, another process extending like- 
wise laterally from either side to the great muscle plates under- 
lying the skin, and still a third process extending out laterally 
on either side to connect with certain special sensory-motor 
organs of the branchial appendages. In the course of evolution 
these branchial appendages have disappeared from the sides of 
the trunk or posterior segments and as a consequence their nerve 
representatives have also vanished, leaving only the motor 
(somatic) and sensory (cutaneous) spinal roots of the spinal nerves 
or their representatives in the sympathetic. As the branchial 
appendages have not yet disappeared from the head or anterior 
segments but on the other hand have undergone radical changes 
in the upward development of the animal for adaptation to the 
medium in which that animal lives, the associated branchial 
nerves have continued in existence but have become warped and 
shifted about in following the changes of the branchial structures. 

The adaptive modifications in the primitive segmental nerves 
, of the head have resulted from several causes. In the first 
place some of the nerves have lost some of their primary com- 
ponents, as for examjole the general cutaneous fibres found want- 
ing in the ix and vii nerves. In the next place, primitive com- 
ponents have been added, as observed in the addition of special 
cutaneous components to the vii nerve. In the third place, not 
a few of the i^rimitive components have been prolonged to take 
the place of or to encroach upon the area of the nerves of other 
segments. In the latter instance, either the terminal organ of 
the nerve has migrated into an adjacent segment carrying the 
nerve along with it or the nerve itself has made a secondary con- 



Cranial Nerves. 287 

nection with an end organ which primarily belonged in a neigh- 
boring segment. 

It is quite obvious therefore that in unraveling these greatly 
modified sensory, motor, and branchial nerves of the head, we 
must remember that the morphological value of each of the sen- 
sory, motor and branchial components of the mammalian nervjes 
can be determined only by their terminal relations, namely, their 
central nuclei and their peripheral end organs. These are con- 
stant whithersoever they migrate and will serve as reliable guides. 

In illustration of what has just been said, note that the motor- 
oculi nerve, though apparently a single nerve, is really an 
amalgamation of several nerves as proved by its multiple nucleus 
and divers muscular terminations. The vagus nerve is a fusion 
of six nerves of the branchial type as shown by the long, blended 
vagus nucleus and the dissimilar visceral structures innervated 
by it. The motor part of the trigeminal nerve is a conglomera- 
tion of a series of six or seven nerves belonging to six or seven 
segments, which causes it to have a singularly long descending 
root and nucleus. Kupffer has demonstrated that in ammocoetes 
the trigeminal itself is formed of the fusion of at least five seg- 
mental nerves. Thus are we slowly unraveling the cranial nerves 
with their motor, sensory and branchial components and assign- 
ing the latter to their respective jDrimitive segments. The task 
is a herculean one but it has been so far accomplished that there 
are indications of many remarkable discoveries to be made in the 
near future. 

As a curious illustration of the possibilities in these future 
discoveries, it is to be noted that Gaskell has already put forth 
the idea that the ventricles of the brain and their prolongation 
into the central canal of the spinal cord, are the remains of the 
primitive alimentary tract. Phylogenetically the brain subdi- 
vides itself into certain well marked divisions. In front is the 
prechordal division with the optic and olfactory apjDara- 
tuses; behind this lies the epichordal brain from which 
originate the cranial nerves. Again the encephalon is 
clearly divisible into a pro-otic region which gives rise to the 
trigeminal and eye-muscle nerves for mastication and eye move- 
ments; and into an opisthotic region containing the vagus group 
of nerves for respiration. The anterior limit of this epichordal 
region is the infundibulum which in the lowest creatures extends 



288 The Fhxus. 

to the ventral surface and which in the higher brain has attached 
to it the hypophysis (pituitary body), recognized embryologically 
as a part of the primitive pharynx before its complete severance. 
This pituitary body, though usually described as a part of the 
brain, is really an outgrowth of the primitive buccal cavity 
(stomadaeum) and the suggestion has been made that it is the 
remnant of an ancestral sense-organ. 

On either side of the infundibulum pass the crura cerebri, 
connecting the prechordal with the epichordal brain. According 
to Gaskell, this infundibulum is nothing more nor less than the 
old oesophageal tube around which the j)rimitive oesophageal 
ring of nervous matter — the ancestral brain — circled. From the 
infundibulum in the nvertebrate on through the neurenteric canal, 
extended the old alimentary tract, reaching thus from the ceph- 
alic stomach to the anus. If this be true, then the central ner- 
vous system consists of two parts, an external nervous part, 
segmental in character, and an internal part, epithelial and non- 
segmental. It is difficult, except upon this phylogenetic basis, 
to explain the tubular character of the central nervous apparatus. 
Certain characteristic diseases of the nervous system and the 
pathological formation of cysts in connection with it, lend color 
to this view of its double nature. Granting this view to be cor- 
rect, the destinction between the segmental nervous structures 
and the non-segmental epithelial tube ought to be more and more 
pronounced the farther we extend our observations down the 
scale of life through the reptiles and amphibians. As a matter 
of fact the distinction does become more and more pronounced as 
is clearly shown in the examination of the brains of Protopterus, 
Lepidosiren and Ammocoetes. 

How natural then that this old oesophageal ring of nervous 
matter, or ancestral brain, should encroach upon the alimentary 
tract in its gradual growth to meet the demands of a higher de- 
velopment. It is by reason of this encroachment of cephaliza- 
tion upon alimentation that certain creatures such as the scorp- 
ions, pedipalpi and spiders have probably been reduced to the 
sucking of blood for nourishment. In the course of time this 
encroachment has become so great that complete severance of 
the alimentary canal has taken place leaving only the infundi- 
bulum as a sort of relic. This is no more extraordinary to under- 
stand than that the pineal gland is the remnant of the old optic 



Cranial Nerves. 289 

process pushed upward to the top of the head from the oesoph- 
ageal ganglionic ring, to form the cyclopean eye; a fact which 
is now admitted by everybody, for the eye is still present in an 
imperfect form in certain fishes (Anguis) and reptiles (Hatteria) 
and other lizards, while embryological observations demonstrate 
beyond a doubt that the pineal gland in many existing higher 
vertebrates still starts as an offshoot of the optic vesicles. 

The chief difficulty in accepting the infundibulum as the 
remnant of an old alimentary canal is met with in attempting to 
explain the formation and development of the present alimentary 
tract. Many searching investigations have yet- to be undertaken 
and many species, of low forms of life have yet to be compared 
before a perfect picture of the evolution of the higher alimentary 
canal can be unfolded. One of the first steps in this investiga, 
tion, and probably the one that will give us the most assistance- 
is the study of the cranial nerves concerned in mastica- 
tion, deglutition, etc. In the study of ammocoetes it is very clear 
that the vagus nerve is not a single nerve but an amalgamation 
of six nerves, each one of which supplies a branchial segment. 
The same evidence shows most conclusively that the seventh 
nerve is also a part of the branchial system of nerves; i. e. it be- 
longs to the group of the vagus and not to that of the trigemi- 
nal. The motor part of the trigeminal is not a single nerve but 
is made up of a series of nerves belonging to six or seven seg- 
ments, all of the prosomatic appendages. The hypoglossal is 
only a cranial nerve in the higher forms of life; in the fishes it is 
a true spinal nerve. 

All of which is highly suggestive as indicating the branchial 
or appendicular origin of the anterior end of the present alimen- 
tary tract; and it is well known that the appendages are caj)able 
of almost any sort of modification under the influence of the 
forces of adaptation. 

The further study of the cranial nerve components will 
doubtless clear up many obscurities now encountered in explain- 
ing the complete evolution of the anterior part of the present 
alimentary tract, especially the mouth. At all events, as C. Jud- 
son Herrick says ' 'our students still memorize the twelve pairs 
of cranial nerves, their trunks, rami and ramuli, with the dis- 
tribution of each, much as one would learn a Greek paradigm," 
which of course is far from being the true, scientific, intelligent 



290 The Plexm. 

and practical way of learning them. Present indications point 
to a far more satisfactory classification of these ""nerves, based 
upon their morphological valuations and physiological functions. 
In comparison with this outlook, the present classification of the 
cranial nerves appears utterly incongruous and absurd. 
EeFERENCES: 

1. Gaskell, W. H. "On the Meaning of the Cranial Nerves". 
Brain: Autumn, 1899. 

2. Herrick, C. Judson, "The Cranial f and First Spinal 
Nerves of Menidia: a Contribution upon the Nerve Components 
of the Bony Fishes." Archives of Neurology and Psijchopathology, 
Vol. II. Nos. 1-2. 

3. Haddon, Introduction to Studi/ of Embryology, p. 163: 

4. Martin, H. Newell, System of Obstetrics by American Authors. 
Vol. I p. 159. 

100 state Street. 



AFTER TREATMENT OF FRACTURES AND DISLO- 
CATIONS. 

By D. N. Eisendrath, M. D., Chicago, 111. 

The only excuse which I can offer for bringing the subject of 
fractures and dislocations before you tonight, is that the fre- 
quency with which they occur both in the practice of the surgeon 
and the general practitioner, and the functionally poor results 
obtained in many of these justices a closer study of the causes 
for the latter and a search for improvement in our modes of 
treatment so as to attain an ideal result in every respect. Before 
proceeding further let me briefly summarize our present methods 
of treatment of fractures. After an immediate or later reduction 
of the displacement we either apply a temporary or permanent 
dressing. The former are represented by side, anterior or pos- 
terior splints of wood, iron, card-board, fibre, zinc, tin or wire 
or the so-called moulded splints of plaster-of-Paris, leather, felt, 
paste-board, or gutta percha. These temporary may serve as 
permanent dressings to which may be added Silicate of Soda, 
Vertical extension, e. g. of the femur in children (Schede) or 
Horizontal Extension (Buck's) or the Double Inclined plane. 

In addition to these various methods of temporary or per- 
manent dressings, treatment of fractures by massage has been 
used to some extent. By some surgeons the ability of massage 
to overcome swelling, stiffness of contiguous joints and dryness 
and coldness of the surface, and atrophy of muscles, has caused 
them to demand that we should treat every variety of fracture by 
this method. It should be limited to cases where the risk of dis- 
placement is slight, as in many fractures at the ankle, wrist and 
elbow and of the fibula. It is often impossible to carry this out 
as few surgeons can devote half an hour daily to the treatment of a 
fracture. The ambulatory treatment was strongly advocated by 
Bruns and others, especially for Potfs fracture and even for 
those of the femur and patella. The claim which has been made 
that there is a great saving in time and earning capacity, is not 
borne out by recent statistics especially those of Krause. There 
are in addition increased risks of displacement. 



292 The Plexus. 

In the treatment of dislocations after the reduction the part 
is usually kept at rest for a period of two to three weeks when 
light passive motion is begun. 

Stiffness of the joints, especially those contiguous or distal 
to the seat of fractures, is a frequent sequel. It is most marked 
in the old and rheumatic or when a sprain accompanies'a fracture. 
•The causes are injury of the muscles, a3dema and infiltration of 
the capsules and paraarticular tissues. Very infrequently there 
is intraarticular effusion at the time of fracture with subsequent 
organization of the fibrinous masses and formation of adhesions. 
Change in the shape of the end of the bone from uncorrected dis- 
placement of a fragment or excessive formation of callus may 
also cause ankylosis. In dislocations we frequently have injury 
to the soft tissues and muscles around joints, in fact the same 
pathological conditions favoring ankylosis as in fractures. 

We have all had experience in which the following is an ex- 
ample. A fracture of the elbow, (supracondyloid) in which the 
arm was kept in a splint or cast for four to six weeks. Upon re- 
moving the dressing, there is atrophy of the muscles of the arm 
and forearm and complete limitation of motion, so that a change 
from the rectangular position in which the arm has been kept is 
accomplished with the greatest difficulty. For four weeks and 
sometimes as many months, sitting after sitting, in which ]3ainf ul 
efforts at passive motion are made, attain but little. The fracture 
itself has healed, there is no displacement, but, alas! what is the 
functional result? This class of cases has interested me greatly 
and I have attempted somewhat of a study of the same. In 
fractures contiguous or into joints, we should pay as much at- 
tention to the function of the joint as to the fracture. We should 
not wait until forcible passive motion is necessary, for as Stimson 
says, "this is harmful before the second month, and even after 
that time it is far more likely to do harm than good. We create 
lacerations which require immediate immobilization in order to 
check inflammatory reaction and which in healing recreate the 
original or similar conditions. In fractures in which there is a 
possibility of the adjacent joint becoming ankylosed, we should 
institute passive motion early, say after two weeks, very gently 
at first, being guided by the amount of inflammatory reaction 
which follows the manipulation. When the joint is accessible, 
massage is of the greatest value. Believing personally, that 



Fractures and Dislocations. 



293 



active motion by the patient himself is one of the best guides to 
the amount of exercise which such joints should have, I have ap- 
plied the well-known mechanical principle of the hinge into casts, 
and after ten to fourteen days in such fractures, especially those 
of the elbow, shoulder and foot, encouraged the patient to make 
voluntary movements. This can be easily utilized by having a 
carriage smith construct out of three-quarters of an inch 
wide iron, a hinged splint one each for the outer 
and inner side of the joint as in the elbow or foot, or an anterior 
and posterior one as in the shoulder. (See Figs. 1 and 2.) These 
are cheap and can be made for each individual case at a minimal 



n 




Fig. 1 

At the end of ten 



Fig. 4 

cost. At the end of ten days, e. g. in a fracture of the elbow, 
the temporary splint is taken off the arm, (the joint itself being 
left free) is wrapped up in sheet wadding, a single layer of 
plaster-of-Paris applied and then the splints held in place while 
other layers are laid over them. We thus have a jointed cast and 
after a few days encourage the patient to make active movements 
which can be gradually increased until at the end of the fourth 
to fifth week, it is surprising how great the range of motion has 
become witheut disturbance of callus formation or displacement. 
In dislocations and fractures, after removal of the dressings, 
massage is an important factor in overcoming the tendency to 



294 



The Plexus. 



ankylosis. If the position of the patient permits, I always refer 
such patients to professional masseurs who can devote i to 1 hour 
daily and in a short time accomplish wonders. Gymnastic appar- 
atus, such as the well-known Whiteley exerciser or the inex- 
pensive apparatus shown in Figure 3, consisting of an ordinary 
pulley screwed into the door frame, a piece of clothes line with 
handle, and a sack of salt or sand weighing from three to seven 
pounds, are of the greatest assistance in overcoming ankylosis 
of the elbow and shoulder. The sack of salt having been pulled from 
the floor by the patient in falling causes]thearm to be pulled down 
in a manner far excelling our manual manipulations. Massage com- 
bined with faradic electricity, hot packs or the hot air apparatus 
is of the greatest aid in overcoming the infiltration, the capsule 





Fig. 2 Fig. 3 

and paraarticular tissues, and the. muscular atrophy (the so-called 
atrophy of inactivity) which invariably folows a fracture or dis- 
location. The massage, etc., may be beyond the reach of our 
poorer patients, but the apparatus which I have shown can be 
purchased for such a small sum, as to be accessible to all. Our 
rule should be never to move a joint when it is still very painful 
and there are signs of reaction, out encourage as soon as possible 
active motion. If we follow, of course, varying it somewhat for 
every case, these principles, ankylosis after fractures and dislo- 
cations, will be far less frequent and the wage-earning capacity 
of our patients correspondingly increased. 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 
UNIVERSITY OF ILLINOIS. 

Editor, H. C. WADDLE, '03. Business Mgr. E. J. MERKI, '02. 

Class Editors: 

H. B. HAMILTON, '00. CHAS. M. NOBLE, 01. PAUL E. ORABOW, 02. 

GUY C. WAUFLE, '03. 



Faculty Departmetit, DR. W. A. PUSEY. Athletic Editor, A. DONKLE, '01 

Alumni Editor, DR. C. C. O'BYRNE, '94. Clinical Department, DR. A. E. GANSEL 

Publishers, MERKI & WADDLE. 

Subscription $1.00 per Annum in advance. Single copies, 15 cents. Issued Monthly 
Send all remittances and communications as to subscriptions and advertising to E. J. 
MERKI, Business Manager, 813 W. Harrison St. 

Entered at Chicago Post Office as Second-Class Matter. 

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Dr. W. T. Eckley who writes the leading article in this issue 
of Plexus is a graduate of the Iowa State University in the class 
of 1884. At present he is Professor of Anatomy in the College 
of Physicians and Surgeons, Chicago Clinical School and North- 
western University Dental School, Chicago. 

Dr. Eckley possesses the faculty of greatly interesting the 
students, who come under his instruction in the subject of Anat- 
omy aid gets a great deal of work from them. Dr. Eckley has 
recognized the fact that frequent reviews are necessary to the 
retention of knowledge and makes the review work a part of 
every day recitation and as a result, in his written reviews which 
come frequently, the members of his classes come to the front 
and do not come up missing as they would do if it were not for the 
constant reviewing. 

When an instructor makes the assertion that a great p er 



296 The Plexus. 

centage of his class has failed or is going to fail, it is but a re- 
flection upon himself and the class is deserving of sympathy, for 
in the majority of cases this instructor has not recognized the 
value of the review and is to blame rather than the student, for 
the condition of aifairs. The success of both instructor and stu- 
dent lies in interest of subject and thorough quizzes following 
well prepared lectures. 

* 

* * 

Dr. Arthur W. Dunning, the author of one of our leading 
articles of this issue, is a graduate of the College of the Physi- 
cians and Surgeons, of the class of 1885. Upon graduation he 
located at Rosendale, Wis. , where he practiced for three years, going 
to St. Paul in 18,s8. For several years he has been giving special 
attention to nervous and mental diseases, and holds the positions 
of clinical instructor in Neurology in the College of Medicine of 
the University of Minn., associate neurologist in the St. Paul 
Free Dispensary, and associate editor of the department of ner- 
vous and mental diseases and medical jurisprudence, of the 
St. Paul Medical Journal. 

* * 

The Chicago River after a half century of stench, filth and 

a cesspool of disease breeding properties, has come and gone 
forever. On its banks soon may be seen Miss White Fish from 
the crystal waters of Lake Michigan sporting with the Bullpout 
of the sluggish stream of the Mississippi, while the pleasure 
crafts glide swiftly over th e limpid waters of the river beautiful^ 
languishing eyes look love to eyes as the strong arm of the love- 
sick swain plys the oars, and the fair enchantress holds the rod 
and line anxiously awaiting for a nibble from a fish or a proposal 
from her beau. While this is going on in Chicago, how is it in 
the neighborhood of St. Louis? This reminds us of a story: 
Long years ago in a little town in this state, an Irishman by the 
name of Jerry Sullivan got drunk and the boys of the place put 
him under the town pump. After being ducked several times 
and almost drowned, he finally managed to get his breath to say: 

"Boys this is fun for youse, but its h on Jerry." And so with 

the Chicago River, it is now the delight of Chicago but hard on 

the people down the river. 

* * 

In the death of General Lawton in battle in the Philippines 
the United States lost oae of its ablest generals, Indiana one o 



EditoHaU 297 

her noblest sons, and his wife one of the best of husbands. He 
won his spurs by and through merit on the battlefield, in the 
camp and on the firing line. If beauty can come out of such a 
great loss it is in seeing the avidity with which the American 
people respond with loosened purse strings to the call for aid to 
assist his widow to raise a mortgage on their home. It was pro 
posed to ask a public subscription to raise iB15,000 for that pur 
poses. This amount was subscribed the first day and then a 
competency for the widow and children was donated in a few 
weeks amounting to about 8100,000; this with the widow's pen- 
sion of a major general will keep the wolf from the door the re- 
mainder of their lives and while it will in no way compensate for 
the death of such a soldier, citizen and husband, it will prove 
that the people of this country are ready and willing to show 
their good feelings in deeds as well as words. 



(DliniGal Separbmenb. 



COLLEGE OF PHYSICIANS AND SURGEONS. 
E. A. Gansel. 

Prof. Newman in his clinics during the present session has 
performed nearly all the major gynecological operations. How- 
ever the most valuable feature of this work is the large variety 
jof ambulatory patients which are always presented at these 
clinics. Every student who begins work as a general practitioner 
will have more or less of this line of work to do and therefore is 
really more interested in the minor cases and operations than he 
is in the major work. 

Prof. T. A. Davis always arranges to have profitable clinics 
and has presented a large number of very interesting and instruc- 
tive cases. Besides giving his general clinics Prof. Davis has 
sectioned the Senior class for surgical bedside instruction at 
Cook County Hospital. He is ably assisted in this work by Profs. 
Ehrman and Eisendrath. The last section of .the class began the 
first week in February, so by the end of the college year every 
student will have had an excellent opportunity of doing bandag- 
ing and coming in direct contact with a large variety of surgical 
work. This is the first year that this special work has been done 
but it will undoubtedly not be the last, for this course is regarded 
by most of the students as a most valuable addition to their sur- 
gical training. 

Since January 12th, Prof. Harper has been unable to con- 
duct his usual eye clinic on Friday afternoon but has furnished 
a very able substitute in the person of Prof. Gamble. Prof. 
Gamble has each week taken up some one of the more common 
diseases of the eye such as a general practitioner will be forced 
to treat and has given the essentials of that disease in a clear 
concise lecture consuming about half the hour. The remainder 
of the hour he has spent in showing cases illustrating the disease 
just lectured upon in its different stages or differently manifested 
in the same stage. Many of these cases he has carefully selected 
from his patients at the Illinois Charitable Eye and Ear Infirmary 
and has had them come up here for the benefit of his class. 



Alumni. 29!) 

These clinics are highly interesting as well as profitable and will 
often be brought up in the minds of the present Senior class 
when during the next few years similar cases fall in their hands 
for treatment. 



Alurpni Deparbmenb. 

'83. M. Robert Weidner, Dalton, 111. 

'84, N. C. Evans paid the College a visit 'recently. The 
doctor is located at Mt. Horeb, Wis. .[and is prosperous. 

'84. Dr. I. H. Reiley of New York, informs us through his 
wife that he is very ill at his home'inithat city. 

'85. M. L. Winstead, Wetang, 111. " 

'88. Dr. M. Cameron, Burwell, Neb., is used up from a large 
exacting practice, and is now at Dr. Newman's Sanitarium on 
LaSalle Ave. 

'88. John F. Glover is » located 'at ■Evansville, Ind. The 
doctor must be prospering since he has paid up his subscription 
to the Plexus until 1902. 

'90. J. P. Ellis, Augusta, 111. 

'90. P. J. Bowen, Mt. Morris, N. Y. 

'91. I. L. Harris, Webster, S. Dak. 

'94. H. Evenson, Newark, 111. 

'94. D. W. Evans, 120 N. Sumner Ave., Scranton, Pa. 

'95. J. P. Rigg:s has removed from Kappa Q to Rose ville. 111. 

'95. J. M. McLean, Coshocton, Ohio, who suffered an injury 
of the knee last September, is now doing post graduate work in 
the city. 

'95. A. E. Miller, Eckert, Colo. 

'95. H. H. Ainsworth has recently located at 433 Flournoy 
St., Chicago. 

'96. T. J, O'Malley is resident physician at the State Peni- 
tentary at Joliet. The doctor sends his year's subscription to 
the Plexus. 

'96. Emil Beck leaves next month for Europe. He will 
study in Berlin, Heidelberg and Zilrich for 8 months. 

'96. A. A. Starner has removed from Mount Hope, Ohio, to 
Danville, Ohio. 

'96. A. E. Brigg, Roseville, Cal. 
'97. W. C. Prough, Goodland, Ind. 



800 The FJexns. 

"97- W. E. Wray, Denmark, Wis. 

'97. F. J. Aby has removed from Norwood Park, 111., to 
Two Rivers, Wis. 

*98. George Rubin who is doing post graduate work in Paris, 
writes requesting that the Plexus be sent to his address, 4 Rue 
Leopold Robert. 

'98. M. A. Bingley, 234 Milwaukee Ave, city., 

"98. Leo L. Cahill, Elizabethtown, New Mexico, reports 
good practice, also plenty of room in that country for hard 
workers. 

'99. W. F. Reich, 422 11th Ave., Milwaukee, Wis. 

"99. F. L. Freas, 1524 Wrightwood Ave., City. 

'99. T. L. Barnes, Bussey, Iowa. 

"99. J. Kreuger, Caldwell, Texas. 

"99. O. E. Mc Williams made a brief call on the editor re- 
cently. The doctor looks prosperous. He is located at Ander- 
son, Ind. 

Word has come to the Plexus, of the death of the wife of 
Dr. F. C. E. Mattison, '88, of Pasadena, Cal. We clip the follow- 
ing from a Pasadena paper: "Mrs. Mattison was a woman of 
charming personality and lovely character and a circle of warm 
friends here in Pasadena and elsew^here mourn her loss." 

'99. Dr. A. C. Croftan was married on Friday Feb. 9th, to 
Miss Elizabeth Pallister Hubbard, at Pasadena, California. The 
Plexus extends best wishes to Dr. Croftan 

'99. Ross D. Long has gone to Pretoria, S. Africa as one of 
the assistant surgeons on the Red Cross Hospital Corps. 

'86. Dr. J. D. McNamara left Chicago for the seat of war 
Feb. 11 . He is surgeon in chief of the Red Cross corps organized 
here to assist on the side of the Boers. The doctor is accom- 
panied by five other physicians and thirty-five orderlies, stretcher 
bearers, etc. The party takes tw^o tons of hospital supplies and 
dressings with them. 



Lihrai}] \(ites. 301 

LIBRARY NOTES. 
Grace W. Bryant, Librarian. 

The Library has received an extensive gift from Dr. H. T. 
Byford, in the form of 161 books and 32 journals. A large num- 
ber of these are transactions of various societies, and as com- 
plete .files of these are necessities of a well equipped medical li- 
brary we are deeply grateful to the Doctor for his gift. A list of 
these books will appear in a later issue. 

Through our exchange system we have added over 500 jour- 
nals, necessary to the completion of our volumes, during the last 
month. These came from the Providence, R. I. Medical Society 
and are all just what we needed. From the Exchange of the 
Assoc, of Medical Librarians we have received 12 fine 7iew books 
a list of which is appended. 

The following articles from the pens of the Faculty have 
been noted in the journals. 

Dr. W. T. Eckley. Anatomical reflections on the pelvic out- 
let. Chicago Clinic, Jan. 1800, p. 20. 

Dr, D. A. K. Steele. Report of a case of cerebellar tumor; 
operation; death; autopsy. Chic. Med. Recorder, Jan. 1900, p. 27. 

NEW BOOKS. 

Birch, DeBurgh — Practical physiology, 1899. 

Brown, Graham — Medical diagnosis. Ed. 4, 1898. 

Dlihrssen, A. — Practical gynecology, 1895, 

Goodall, E. W. & Washburn, J. W. — Infectious diseases. 

Gould, G. M. — Student's medical dictionary. Ed. 10, 1899. 

Hollopeter, W. C— Hayfever, 1898. 

Jacobson, W. H. A. — Surgical operations, 1889. 

Kenwood, H. R.- — Public health laboratory work, 1893. 

Morris, Henry — Renal surgery, 1898. 

" " — ^Human anatomy, 1899. 

Thorington, James — Refraction and how to refract, 1900. 
Tyson, James — Practice of medicine, 1898. 

GIFTS. 

Corwin, A. M.— Physical diagnosis. Ed. 2,1896. Dr. A. H 
Brumback, donor. 

Loomis, A. L. — Physical diagnosis. Ed. 10, 1896. Dr. A. H. 
Brumback, donor. 

Lemke, A. F. — Pulmonary tuberculosis, 1899. Dr. A. F. 
Lemke, donor. 



30 2. The Plexus 

THE QUINE LIBRARY. 

Since the course of medical education has been extended to 
four years, newer and better methods of teaching have been de- 
manded. A good working medical library is a necessary adjunct 
to a well-equipped school of medicine. The late A. Reeves Jack- 
son, first president of the School of Medicine of the University of 
Illinois, left his library to the school at his death. To this 
nucleus additions were gradually made, until in 1895 the library 
was organized under the Dewey Decimal system with about 1,100 
volumes. Since that time it has grown steadily both in quantity 
and quality, showing an addition of 1,200 volumes within the last 
two years, At the present time it contains about 3,400 bound 
volumes, 400 unbound volumes, f,000 pamphlets, and hundreds of 
volumes of unbound journals not in complete sets. An elaborate 
exchange is maintained whereby duplicate journals are exchanged 
for those needed to complete files. All the current periodicals 
are kejDt on file. It is a reference library only and it is open all 
day. A trained librarian is in constant attendance. The second 
floor of the Laboratory building has been fitted up with plain 
library furniture and the books, carefully classified and cata- 
logued, have been placed upon convenient shelves. This part of 
the building is practically fireproof. 

In the number of its volumes, and the amount of its working 
material, this library stands first in Chicago after the medical de- 
partment of the Newberry library. Its average daily attendance 
of ninety exceeds that of the Newberry. 

A great deal of reference work is done in this library, over 
fifty lists having been made last year, taxing the library to its 
utmost. In 1899 it received in the way of gifts, 650 books, 1,000 
pamphlets and 5,000 journals. 

In recognition of the hundreds of volumes donated by Dr. 
William E. Quine, dean of the school, and his endowment of |300 
a year, the faculty has conferred his name upon the library. 

Friends of the school and of higher education are earnestly 
solicited to donate to the library books, journals, reprints or 
money. Correspondence may be opened with the Libraian of the 
College of Physicians and Surgeons, 815 West Harrison street, 
Chicago. — University Bulletin. 



SENIOR NOTES. 

"iVb7i Nobis Solum.'" 

Sassaman propounds the following: What dose of calis- 
thenics will cure a case of insomnia due to sleeplessness com- 
plicated by a cystic murmur? 

Owing to the fact that "exams" have been "permanently 
abolished,"' we have been having a few "written quizzes." 

Dr. — : Mr. Parsons, will you define epilepsy? Parsons, (very 
wisely): It is fits with or without symptoms. 

Masilko has discovered a new species of tapeworm, viz., 
the "Bacillus Coli Communis." 

Dr. Murphy made a short visit in Indian Territory. For one 
day at least his, "Come down please" and that feeling of "gone- 
ness" at the pit of your stomach that is associated with it when 
your own name is called was a matter of memory. During his 
absence Dr. Lee conducted the clinic. 

Dr. Monahan, "the crack shot of Iowa," came within one of 
getting the burglar. Ask him to explain just how it happened. 

The difficulty between "Iowa" and "Turkey" over disputed 
territory has been amicably settled, the latter rather hastily but 
gracefully withdrawing. 

Judging from the dexterity with which some of the class 
handle snow, one might be led to believe that at some time in 
their history they had cleaned the sidewalks, or belonged to the 
street cleaning force. 

Thequestion everybody asks every body else: "Have you got 
your letter?" 

With "exams," quizzes, caps and gowns, pictures, new 
clothes, diplomas, state boards, getting married, locations, etc., 
etc., the senior's mental processes must involve a series of 
mechanical intricacies that would puzzle an Eddison. 

The routine of school work was varied on Feb. 9 when the 
class, through its president presented Dr. Quine with a small re- 
membrance of his 53rd birthday. The memento was a small 
locket on one side of which were the letters "U. I.", and on the 
other, "P. and S.", while on the inside were the words, "Orator, 



304: The Plexus. 

Teacher, and Friend", sentiments which every member of the 
class heartily endorsed. Dr. Quine responded in a few words, 
mingled with witicism, and earnestness as is characteristic of him, 
and which to attempt to report were but to mar. 



JUNIOR NOTES. 



Sternberg ran up against rather a hard proposition when he 
tried to fracture the base of the lower amphitheatre with his head 
as a battering ram 

Reports are coming in from good authority that one of our 
class who comes from the central part of Illinois is taking chil- 
dren to raise, principally of the gentle sex and ages from 10 to 
12 years. 

$100.00 REWARD. 

The above named reward will be paid to parties who will give 
information leading to arrest and conviction of party or parties 
(principally D. J.s) guilty of driving nails in the stairs thereby 
causing our first assistant pathologist, Dr. Soegaard to fall on 
his neck which caused him to loose his hold on the dead dog's 
tail which he was escourting down to be posted. Send any infor- 
mation to Dr. Soegaard. 
Prof. H. E. Smith. 
H. E. S. Here. 

Prof. What is the difference between a high and a low 
tracheotomy? 

H. E. S. Why, one is high and the other is low . 
We trust that all those who were disappointed in not getting 
letters from the faculty have become reconciled to their fate. 

The concert given by the Glee Club was a brilliant success 
and we must admit that this was due more to the spirit of the 
junior class than to anything else. We were very well repre- 
sented both on the stage and in the audience. 

Have you sat for your picture for the college album? If not 
you had better get in the swim. 

SOPHOMORE NOTES. 

Corcoran has discovered a new muscle; viz., Flexor carpi 
ulnaris digitalis. In honor of the discoverer it is hinted, the 
faculty will call it Flexor carpi ulnaris Corcoranibus. 



Notes. 305 

Low is now singing: "Low, Low, sweet and Low wind of the 
western sea,"" to his gitta bitta baba; Popsy's litta duckie. 

George Zohrlaut has now plenty of time to consider the 
question "Is Marriage a Failure?'" 

One night not long ago a very deep hase with a flute-Uke ten- 
or rang out ujDon the air with these words: "And I'll never ask a 
question any more." The singers proved to be Shelton and 
Grabow. 

Kirch fell violently in love the other day. It is strange how 
pleasant and agreeable this calf-love can make one, at least so 
say his neighbors in the laboratory. 

Now that Kentucky has gone home, Phifer will have his 
Kitterman again, and Kitterman (and his Phifer) can again be 
found m his room, (occassionally) when not at lectures. 

There seems to be a constant demand coming from certain 
quarters for "Soa.sfs" in these columns. Now a "Roast,"' as inter- 
preted by these people, is any description which will in some 
way exhibit the unfortunate one in a most peculiar rediculous- 
ness or even impugn his character. The more pungent, sarcas- 
tic or cutting, the more it approaches its limit "Roast." It is 
not the object of the Plexits to subserve the desires of the baser- 
element, nor to cater to such who wish to defile with fool jibes, 
but in this issue let us abridge the full meaning of "Roast'" and 
give a "Roast" or two. May it sizzle with truth and cut like a 
two edged sword, and may the Roasters be satisfied, and forever 
Roasted. 

Boast. There are people in this world who are always late. 
They could be on time no more than they could pass through the 
proverbial needle's eye. The sad fact is that if these dilatory 
mortals were only nuisances to themselves, no one but themselves 
would suffer, but as it is, they inflict their short comings with 
dire results upon many. Suppose for example a lecture does not 
begin before twenty to thirty minutes after the hour, what hap- 
pens in the interim? Some student — no — not a student, but a 
lunatic not yet incarcerated — at once strikes a match and hurls it 
down upon the lower rows. What a bright idea that was! Old 
Simple Simon himself out-Simoned. Next some other youth with 
an excess of cerebral ventricles finds exceeding delight in throw- 
ing a burning newspaper upon the head of some unsuspecting 
student below. For down right fun that beats every thing. See 



306 The Plexus. 

the grin on his face. Lines of degeneracy in every move. Look 
at that bullet head with the Nero nose, and Marat's chin. See 
that Robespierre eye: Malicious idiocy written in every feature. 
Next comes he who never regained his proper equilbrium 
from podallic version. His feet are first, every where. There 
is just one bump on that solid "nut" of his, and that is the bump 
of destruction. He does it with his feet. There are people whose 
destructive %>^nchant lies in marking, whittling and defacing in 
various ways — but this booby kicks. In fifteen minutes he can 
kick the back off of every seat in a row, and he does it too. The 
seats destroyed in L. A. the last year have been done by a few 
of the above kickers. Darwin calls these a "reversion to type." 
The type being the jack ass and the mule. -What these things 
are doing in a medical college is a question. How they ever got 
in is a greater wonder still. Yet when one reflects he will see 
that human institutions, from time immemorial have always had 
their quota of fools; they are like the poor, which the Good Book 
says, are with us always. 

If there is a good all round man, "Rosey" is that man. His 
last venture is one of slinging dishes at the frat house. Rosey 
now thinks, "Uneasy lies the head that wears the crown" 

Why did E. A. Garrett and Henderson have to move? Did 
they have too many friends and relatives? 

Old Nebraska Caldwell looks like a new dish at Coe's morgue 
since his hair cut.i 

Berger and Brownstein, it is reported are going to 'join the Fen- 
ian invasion into Canada. 

To wash or not to wash, ^hat is the question, whether it is 
better to suffer the slings and snares of out raged class-mates or 
give myself a scrub and comb --Aye, there's the rub. 

Mc E. 



FRESHMEN NOTES. 



To- 



Like others did in time now past 
At start of song their Muse invoke, 

Will I also. Then to the last 
Aid me in this — this triple yoke. 

Help me to tell How ard some find 

Their duties here. How some are bent 



jSlotes. 307 

From them. To those that come behind; 
Grant them, O Muse! encouragement. 

Know oft some minds are in a Hayes, 

At stated times they've not the Poicer', 
To tell their thoug-hts. In diverse ways 

They're hampered in this search for lore. 

Thev may know Moore than others — quite, 

Hon do much less; but, when they've Dunn 
Their very best, try as they might 

They stop; confused, their course is run. 

But when the Right man to the end 

Be to their failurej lenient, 
They're Sure to Pick it up, my friend 

With patience and encouragement. 

Then should some Pooi' man fall aside 

From righteous paths, tho Smith or King, 
Give him your hand — stoop not to pride. 

Encourage him — that's everything. 

The Shepherd tho he's tired and worn 

Without the Lamb for Holme (.s) ne'er starts, 
Pipe like the shepherd— B lough thy Horn, ■ 

Call for the whole — search for the parts. 

Know Howe a kindness rightly given 

Is Oold en silver unalloyed. 
It costs us naught — 'tis known in Heaven, 

Makes some one happy — overjoyed . 

Then when Mey ers and yours are gray, 

And Joyce of youth give way to (g) Beeves; 
When we have striven night and day 

To cast our net from stormy reefs; 

When there are Fucik, and we know 

That those who Wockos late at night 
(When Wicks were snuffed) are now Oelow 

In hotter climes, where all is bright; 

When as I say your course Uran, 

Strove hard to aid the weaker one; 
Been candid, broad — been just a man, 

We'll say with one accord — Wei d one. 

Just as the Martin skims the air 

In crooked paths — just so are men. 
Forgive, forget — -their load help bear, 

Be first to praise — last to condemn. 

J. D. 

Recently the class nearly went into hysterics when Mr. 



309 The Plexus. 

Zelowsky announced through one of its members, that he de- 
scended from royal ancestry. If Mr. Z. wishes to continue the 
adminstration of such drugs, he had better do in homoepathic 
doses for the class seem to have a decided idiosyncrasy. 



THE DOCTOR'S WOOING. 

"Tis said a .very young M, D. 
Once loved a maiden fair to see, 
And thus this doctor very young, 
The lovely maiden s praises sung: 

" How enchanting is thine azure iris, 
Shining "gainst the white scleroid; 
Gracefully attached the tendon 
Of they sterno-cleido-mastoid. 

Capillary hy perm alia — 

Of its tints the name is legion. 

So pellucid is thy epidermis 
In the oro-buccal region. 

Of its glorious tints the sunset's 

But a feeble imitator; 
Oh, my darling, do but let me 

Osculate your buccinator. 

Than thy oral epithelium 

Nought this side of heaven is sweeter 
Graceful are the sinuous outlines 

Of thy beautiful masseter. 

Then thy zygomaticus major 

Gives me joy almost divine 
Whene'er it and thy risorius 

In active league combine. 

Empty is my pericardium. 
Of its tenent thou bereft it; 

Auricle and ventricle 

And aorta's base have left it. 

Yet I wish not to regain them; 

No wish have 1 but that you 

Will take also my peritoneum, 



Ahmmi Concert. 309 

And my encephalon, too. 

Give me but thy sweet phalanges, 

Thy metacarpals press to mine, 
My cerebrum, cerebellum, 

May they e'er be slave to thine. 

Precious darling, come auscult me. 

Thy concha 'gainst my thorax pressed. 

On my blest manubrium ever 
May thy precious cranium rest." 

The doctor has never ceased to wonder 
Why she bade him go to thunder. 

— A. E. Orr in The Phagocyte. 

OUR ANNUAL CONCERT. 

The second annual concert given by the Mandolin, Guitar and 
Glee Clubs of the College of Physicians and Surgeons was given 
at Steinway hall, February 15, 1900. The entertainment was 
quite good but only fairlyiwell attended. The following program 
was rendered, interspersed by frequent encores: 

PART ONE. 

All Aboard for Podunk Steele 

Glee Club 

The Fortune Teller Herbert 

Mandolin Club 

Banjo Solo 

Mr. Ralph F. Palmer 

Selection 

Quartette 

Smokey Mokes » Holzman 

Mandolin Club 

My Wild Irish Rose , Olcott 

Glee Club 

PART TWO. 

At Coontown's Picnic Hans Line 

Mr. Barnes with Glee and Mandolin Clubs 

Catawba Wine Clougli-Leighter 

Mr. B. L. Millspaug-h 

The Ameer Herbert 

Mandolin Club 
Sweet Pimg-E-Wan g.. . , Steele 

Banjo Solo 

Mr. Ralph F. Palmer 

Little Cotton Dolly Geibel 

Glee Club 

The following constitute the members of the interested clubs: 



310 The Plexus. 

Glee Club — Director, D. A. Clippinger; Manager, G. A. Colburn; 
Secretary, F. E. Brawley; Leader, A. J. Ames. First Tenors, 
R. G. Gale, J. A. Rolfe, J. D. Garrett, Wm. Seabrook, C. V. 
"VYiltfong. Second Tenors, E. W. Burke, J. A. Gustafson, P. E. 
Grabow, G. M. Hawkins, Schaffer. First Base, A. J. Ames, 
G. A. Colburn, G. G. Zohrlaut, F. E. Brawley, R. J. Holnberg. 
Second Base, L. W. Clark, Ivan Parry, P. G. Kittermann,Wm. R. 
Severson, D. F. Webster. 

Quartette — R. G. Gale. J. D, Garrett, A. J. Ames, Wm. R. 
Severson. 

Mandolin Club— Leader, G. A. Colburn. Mandolins, F. E. 
Brawley, G. G. Zohrlaut, E. J. Fucik, G. A. Colburn, Max Hoff- 
mann, Leroy Sibley, H. J. Forbes. Guitars — P. E. Grabow, 
E. W. Poinier, H. Goodhue. Banjo — R. F. Palmer, 



NEWS ITEMS 



Dr. L. Harrison Mettler gave an illustrated lecture on Friday 
Feb. 16, on "How Men Live — Respiration Circulation and Di- 
gestion." This is one of the Free Lecture Course given to the 
People of Chicago by the F^ecord. 

For the past three years, the College of Physicians and Sur- 
geons has been affiliated with the State University of 111. Re- 
cently this union was made more absolute at a conference of the 
legal representatives of both institutions. 

Briefly stated the contract provides: (1) that the value of the 
real and personal property, equipment, and good will of the Col- 
lege of Physicians and Surgeons is, for the purpose of this agree- 
ment, 'S217,000: (2) that this entire property shall be leased to the 
University for the term of twenty-five years, or until the termina- 
tion of the agreement, at $12,000 per year and taxes and [assess- 
ments: (3) that the net earnings shall in the meantime^belong to 
the two institutions and that out of what has accruedjin the 'three 
years during which the College of Physicians and Surgeons has 
the school of medicine of the University, the University shall 
have and' owns $8, 000 and the College the remainder, and that 
hereafter the University shall have one-third and the stock-hold- 
ers of the College two- thirds of the net earnings: (4) that the 
College shall forthwith make a sufficient conveyance to the Uni- 
versity "in escrow" of all its property and good will: (5) that the 
share of the University in the net earnings shall be paid'annually 



N^etos Items. 311 

in cash and be set apart in a separate fund for the purchase of 
the property and kept invested: (6) that when this fund equals the 
purchase price of the property it shall be paid over and the con- 
veyance delivered, with the option to close the matter out by pay 
ing the existing difference in cash at the end of twenty-five years 
if the agreement is not already consummated: (7) that during the 
continuance of the lease the right of initiative as to the policy of, 
and appointments to the College shall be with the President of 
the University, but that ultimate authority shall be with the 
Board of Trustees, and any enlargement of expenditures shall be 
by current action: (8) that the University will use the revenues 
of the College to upbuild the same and advance medical science 
without being confined to any particular branches of study or 
methods of instruction: (9) that the College shall not carry on 
any medical work except in connection with the University: (10) 
that the University shall not be bound to pay any moneys what- 
ever in connection with the matter except out of the revenues of 
the College of Medicine. 

Many minor details claimed close attention and are referred 
to in the formal agreement, but the foregoing is a statement of 
all points believed to be important. 




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EDWARD H. J.KE. M. I>. 



SCHOENBORN-BEELE SPLINT. 
By Edward H. Lee, M. D. 

Professor Surgery Chicag-o Clinical School, Surgeon Cook County Hospital, 
West Side Hospital and Alexian Brothers' Hospital, Chicago. 

In 1891, during my term of service as interne under Prof. 
Schoenborn at the Julius Hospital in Wuerzburg, Germany, I had 
the opportunity of becoming familiar with the making and appli- 
cation of the Schoenborn-Beele splint. For years previous to 
this time this splint had been in use at the Julius Hospital, and I 
understand is still in use there. The results in treating fractures 
by this method were uniformly satisfactory. For the past seven 
years I have used this method in the County Hospital, the Alexian 
Brothers' Hospital and in private practice in a great number of 
cases; it has been used extensively by a number of the internes 
of the County Hospital and by some of the members of the attend- 
ing staff. Where I have been able to give the necessary time and 
care to the patient, my results have been good. 

Among the many advantages which the splint offers are: 
That it can be applied immediately; is light and neat; there is no 
necessity of padding with cotton; it is not apt to produce decubi- 
tus; it may be removed and put back in place in a very short time, 
and the cost of the material is but very little. I know of no other 
splint that will adapt itself so perfectly to the form of the limb 
as this one. 

In describing its application to various special fractures, I 
hope to be able to show its advantages in many other respects. 
At the present time, I do not construct the splint in the same 
manner that Schoenborn does, as I find, and will later describe, 
that in using ordinary plaster-of-paris bandages it is possible to 
make a neater splint and make it in less time and with less trouble 
than by the original method. The material, as Schoenborn uses, 
consists of of plaster-of-paris, hemp, bandages, and, in cases 
where elevation and extension is desired, rings and adhesive 
strips. The hemp used is the ordinary bulk hemp employed 
making rope. The fibers of the hemp should be parallel and of 
equal length. Bundles of these fibers are made up, the length 
and the thickness of the bundles depending upon the length and 



316 The Plexus. 

the strength of the splint desired. These bundles are hung 
separately over the back of the chair, or some object, so that 
they are conveniently at hand when needed. The hemp may be 
substituted by other material, such as fibers of wool, etc. How- 
ever, hemp absorbs the plaster better than any other material 
and is also cheaper. The plaster-of-paris to be used must be 
good, so that the splint will harden within a very short time after 
it is finished. The best plaster to use is the finest dental plaster. 
A mixture of plaster and water is made in the following manner: 
First, the water is poured into a vessel, then dry plaster is grad- 
ually added, the water and plaster being kept stirred so as to 
prevent a caking of the latter, until about equal parts have been 
mixed or until a somewhat mushy substance of uniform consist- 
ency has been made; it is better not to make the plaster too 
thick until becoming familiar with the making of the splint, as it 
rapidly becomes hard and may be unfit for use before the splint 
is finished. The bundles of hemp are now dipped into the mix- 
ture of plaster, are thoroughly saturated with it, and then wrung 
out by holding one end of a bundle in one hand and allowing the 
entire length of the bundle to pass through two fingers of ihe 
other hand, which presses out a large amount of the plaster, and 
at the same time flattens out the bundle. This bundle is now 
placed parallel to the longitudinal axis of the limb, over the sur- 
face where the splint is to be built, and is followed by additional 
bundles until the desired surface is covered. Some of the plaster 
mixture may be smeared over the surface of the dressing, so as 
to fill up any crevices which may exist and to give the splint a 
smoother and neater finish as well as additional strength. At 
first one is inclined to make the splint unnecessarily heavy and 
thick, so that it may have a clumsy appearance; a heavy splint 
sets more rapidly and the weight of the splint, even though 
bulky, is not apt to give rise to decubitus and does not cause in- 
coavenience by "its weight. The average weights for splints are 
as follows: 

Forearm and hand. 370 grams. 

Arm, forearm and hand 511 grams* 

Shoulder, arm, forearm and hand.... 700 grams. 

Foot and leg 515 grams. 

Thigh and leg 980 grams. 

Thigh and log, with suspension rings.. 1,050 grams. 
If suspension is required, as many rings as are necessary^are 



Splints. 317 

slipped over a bundle of hemp or over a plaster bandage and the 
rings placed on the surface of the splint in the desired position. 
The points of the rings may be reinforced by short bundles, 
which are placed transversely over each side of a ring. Exten- 
sion is applied in the ordinary manner by adhesive strips and 
circular bandage or by means of a glue dressing. 

As soon as the splint has become fairly hard it can be tied to 
the limb by strips of bandages; when it is perfectly hard it is se- 
cured by roller bandages, applied to the limb along the entire 
length of the splint. If the growth of hair is abundant, the splint 
IS liable to stick; this may be avoided by either shaving the limb 
or oiling it before applying the plaster, or a thin strip of linen or 
flannel may be placed next the skin before applying the plaster. 
I do not use any of these precautions, as I have had but very lit- 
tle trouble in this respect. 

The modification which I use in making the splint is as fol- 
lows: Instead of using hemp and a plaster mixture, I simply use 
roller bandages of plaster-of-paris, which are first soaked in a 
warm salt solution and then are run up and down the limb over 
the desired space. An many thicknesses of bandages are used as 
is necessary to form a strong splint. Usually from five to eight 
thicknesses will be sufficient. By using this method, I find that a 
neater splint can be made, with very much less trouble and 
assistance. 

Before describing its application to various fractures, I should 
like to emphasize the following points: 

The plaster must be good, for reasons before mentioned. 
Before applying the splint the fracture should be perfectly re- 
duced apd should be held in perfect position while the splint is 
being made and until it is hard. The extremity should be placed 
in a position which will favor the retention of the fractured ends, 
and in a position which will facilitate the application of the splint. 
The width of the splint should be about one-third the circumfer- 
ence of the limb: in fractures of the forearm and leg they should 
be made broad enough so that the roller bandages which hold the 
splint in position are not apt to press the fractured ends of dif- 
ferent bones toward each other. It is desirable to remove the 
splint on the third or fourth day, and after this time every four 
to eight days, in order to inspect the parts and have them under 
perfect control. 

The application of the splint to special fractures: 



318 The Plexus. 

Fracture of the Humerus. Here the splint differs in construc- 
tion, according to the seat of fracture, if in the upper, middle or 
lower third. In all three cases, it is desirable to have the patient 
up and around during the entire period of treatment. It is often 
necessary to depend upon the weight of the arm below the frac- 
ture to exert extension and overcome longitudinal displacement, 
should it be present. That is, an ambulatory extension is ef- 
fected, and in the greater number of cases it is sufficient to over- 
come any deformity which is produced by muscular contraction. 
In fractures of the upper third, the splint is not effective if it does 
not extend above the shoulder and practically immobilize the 
shoulder- joint. (See Fig. 1.) 

This is accomplished by a shoulder cap. I speak of a prac- 
tical immobilization of the shoulder and arm which would pre- 
vent any motion whatever and absolute immobilization would 
make the patient most uncomfortable, especially when in the re- 
cumbent position, where it would be difficult to place the arm in a 
position where it would find support. Allowing a limited amount 
of motion, the patient will be able to assume a position in which 
the am rests comfortably. 

To apply the splint in fractures of the upper third the pa- 
tient is stripped to the waist, sits on a stool, leaning slightly 
backward, or stands. An assistant, sitting in front of the patient, 
reduces the fracture and holds the arm in position in the follow- 
ing manner: The forearm is flexed at a right angle to the arm; 
the wrist is held with one hand; one or two fingers of the other 
hand are inserted from below and behind into the fold of the 
elbow, and gradual traction is made until any longitudinal de- 
formity is overcome. The hand is held in a position midway be- 
tween supination and pronation, the elbow is held at a slight 
distance from the thorax, the forearm points forward and inward. 
In some cases it may be necessary to place a pad temporarily be- 
tween the thorax and the lower fragment, in order to prevent an 
inward displacement of it, or it may be necessary to hold the 
arm in abduction in order to accommodate the abduction of the 
upper fragment. The splint should extend well above the shoul- 
der, reaching as far forward as the middle of the clavicle; in 
front it should reach below the clavicle as far as the third or 
fourth rib; behind it should extend to the lower angle of the 
scapula. It should extend downward on the outer side of the arm 
about one-third of its width to the external condyle, not including 



Splints. 319 

the external condyle, so that the elbow- joint remains free and is 
not in any way supported by the splint from below; as soon as 
the splint is continued over the surface of the forearm to the 
wrist in a similar manner it is completed. It should be made very 
strongnear the elbow, as it may have to bear the entire weight of 
the forearm. A ring may be inserted at the lower end near the 
wrist, from which it may be suspended by a strip of bandage around 
the neck. After the splint has been hardened, it is secured to the 
arm, shoulder and thorax by means of bandages. (See Fig. 2). 

The bandages around the elbow and forearm should not be 
tight, so that the weight of the forearm may exert exten- 
sion. 

In fractures of the middle third the shoulder cap may be 
omitted, but the splint should extend well up onto the shoulder. 
(See Fig. 3). 

In fractures of the lower end there is necessity for fixation 
of the shoulder-joint, but the splint should extend well up to the 
upper third of the humerus. 

The advantages of treating fractures of the humerus by this 
method are: That the axilla is free; that the thorax is free, so 
that no chafing occurs, as may take place when the thorax itself 
is used as a splint. There is a limited amount of motion present, 
which does not interfere with the seat of fracture. A certain 
amount of ambulatory extension is exerted, which undoubtedly is 
of great benefit in certain cases. The splint may be removed 
without any great trouble and can be placed in exactly the same 
position after the fracture has been inspected. 

I will not go into detail of the treatment of fractures of the 
elbow and of the forearm. The splint is applied in a similar 
manner in fractures of the elbow and in fractures of the fore- 
arm. In fractures of the elbow the splint extends from the mid- 
dle of the arm along its outer surface, to the ends of the meta- 
carpal bones. The splint may include the posterior sur- 
face of the elbow- joint, if desired, and a sort of a trough may be 
constructed for the entire joint. (See Fig. 4). 

In fractures of the forearm the splint may be constructed so 
as to immobilize the elbow- joint or not, according to the relation 
of the fracture to the elbow- joint. The forearm is always placed 
in a favorable position after the reduction of the fracture has 
been effected, for the application of the splint over the anterior 
surface. In Colles' fracture the arm is placed over a pad mid- 



320 



The Plexus. 





Splints. 321 

way between supination and pronation and the splint applied as 
is shown in Fig. 5. 

Fractures of the Loiver Extremides. First, fractures of the 
femur: The splint is applied in the same manner to all fractures 
of the femur, whether of the neck or of the shaft. The patient 
is placed flat upon the back; if possible, on a table; however, if 
this is not convenient, the bed may be used. An assistant re- 
duces the fracture and holds the limb in position in the following 
manner: The heel is grasped with one hand and the toes with 
the other. The outer rotation is reduced by turning the foot in- 
ward. The longitudinal displacement is reduced by extension. 
A small pad is placed under the knee, so as not to have the knee- 
joint at full extension, which would be apt to give the patient 
pain. If the fracture cannot be reduced without an anesthetic, 
one should be administered, after which almost any fracture can 
be reduced without any trouble. After the fracture has been 
perfectly reduced the splint is applied along the anterior surface 
of the leg, commencing as high as possible in the inguinal region, 
covering about one-third the width the entire thigh, extending 
along the surface of the thigh over the knee on to the leg in pro- 
portionate size and on to the dorsum of the foot up as far as the 
toes. The foot is held at right angles to the leg, so that the very 
unpleasant complication of "drop foot," which frequently results 
from the weight of the bed clothes, or even from the weight of 
the foot itself, is avoided. Four or five rings are inserted on the 
upper surface of the splint, a little to the outer side of the median 
line, so that when suspended the leg will have a tendency to turn 
inward. After the splint is hard it is secured to the leg by 
means of roller bandages. (See Figs. 6 and 7). It is now sus- 
pended by means of cords, which pass through the rings and are 
fastened to a frame, which is secured over the bed. (See Fig.7). 
The extension strips, which were placed in position to both sides 
of the leg by means ot circular bandages, before the splint itself 
was applied, are attached to a cord, which runs over a pulley 
through the end of the frame, and the necessary weight is at- 
tached to the cord. In applying the splint in this way we have 
elevation, suspension and extension of the extremity. There is 
absolutely no splint material In the bed itself. The leg swings 
on the suspended cords. The patient can move about in bed a nd 
is perfectly comfortable. The bed clothes can be changed wit h 



322 The Plexus. 

out any great trouble and the bed pan can be used without 
difficulty. 

In fractures below the knee the splint is applied in a manner 
very similar to that of the forearm. The fractures are reduced 
by extension or by such manipulation as is necessary, and the 
splint applied to the anterior surface of the leg. In Pott's frac- 
ture the foot is placed in forced inversion, as is customary in the 
reduction of this fracture. 

The splint may also be applied to advantage after resection 
of the knee-joint by moulding a splint above and below the knee,. 
leaving the knee-joint free. The splints above and below the 
knee are connected by a curved iron or steel brace. Rings are 
inserted in the splints, so that the leg may be elevated and sus- 
pended, as in fractures of the femur. The knee-joint can be 
dressed without interfering with the splint and the patient is 
very comfortable during the entire treatment. (See Figs. & 
and 9). 




.T. C. O'DAY, M. D, 



CANNABIS INDICA POISONING. 

J. C. O'Day, M. D., Member of Senior Class. 

Believing an experience I once had with cannabis indica to 
be of interest to some of the readers of the Plexus, will be my 
apology for contributing this article. 

It has never been the inclination of the writer to indulge the 
feeling of egotism; and as the pronoun I may appear frequently, 
you will please bear in mind my desire of accurately and truth- 
fully recounting the event as it actually occurred. 

Some few years prior to my taking up the study of medicine, 
I was employed in northwestern 'Pennsylvania as locomotive en- 
gineer on the Bradford, Bordell' & Kinzua Railway. My run was 
to double the road with the way-freight. 

One day I pulled into Bradford suffering with an attack of 
acute bronchitis, and, having a few minutes to spare, ran over to 
a corner drugstore to consult the clerk about my cough. He 
recommended Piso's Cure for. Consumption, and I bought a bottle 
and returned to my engine. 

Taking a mouthful of the cure I completed the shifting of 
the freight cars in the yard and made up my train for the, trip 
out. This consumed about one-half hour. Before leaving the 
yard the conductor (George Caswell) came to the engine telling 
me we had two car loads of cinders in our train and instructed 
me to stop at ''Hard Scrable '" that the Italian section hands 
might unload the cinders. 

My cough was very distressing, and so, as we sped along, I 
made frequent requisition on the bottle. The more I partook the 
more I had need l^o partake. 

We had covered about seven miles of the road when I sud- 
denly became aware that I had been dreaming, and that I had 
forgotten that the responsibility for the safety of the engine and 
the train rested on my shoulders. The realization of this respon- 
cibility shocked me, but did not dispel an illusion that one of my 
legs was larger than the top of the smoke-stack, my arms like 
ponderous levers and my hands capable of encircling a flour 
barrel. 

.Tust then my fireman yelled, "O'Day, what is the matter with 



326 The Plexus, 

you?" and the conductor came clambering over the tender, call- 
ing to me to know why I had not stoped at Hard Scrable to allow 
the unloading of the cinders. About this time I began to realize 
that I had been imbibing too freely of Piso's Cure, and made a 
desperate effort to concentrate my mind on my work. I reversed 
my engine and backed away toward the dumping spot. Looking 
back I was astonished to find that my train appeared to be more 
than a mile long, and that the Italian shovelers on the loads of 
cinders were expanding into enormous misty phantoms. 

The sight unnerved me, and I again forgot to stop at Hard 
Scrable. So wrapped up in the novelty of my new surroundings 
was I that I forgot my place at the lever until the conductor came 
forward the second time and told the fireman I must be going 
crazy. This sobered me somewhat and the ashes were at last 
dumped at the desired place. 

Before starting again I began to wander away into a land of 
giants and monsters, and fearing that some erratic impulse might 
seize me I told the fireman to watch me closely and to take charge 
of the engine if he saw anything wrong with me. 

As I responded to the signal to go ahead, I noticed the great 
length of my engine. The telegraph poles .shot upward until 
their cross-arms pierced the blue vault above. Dogs as large as 
Durham bulls ran out and barked at us as we passed. Flocks of 
English sparrows with spread of wing greater than the condor 
rose from the road-bed and flew away. I had run over the road 
day and night for some years, until I knew every whistling post, 
but things did not have the old familiar look, and I could not tell 
whether I was running up grade or down, and was curious to see 
what the next curve would reveal. The cab grew to enormous 
proportions, and the fireman stood at his post more than one hun- 
dred feet away. 

After what seemed to be days of running, and when we had 
covered what seemed hundreds of miles of track, I began to 
realize that we were nearing Kinzua Junction, and I slowed up. 

The effects of the drug were wearing away and were soon 
gone, so that I knew how to handle my engine, and persons and 
objects shrank down to their old proportions. 

The intoxication did not last more than three-quarters of an 
hour. 

When a student of medicine in Baltimore, I ran across Prof. 
H. C. Wood's classic description of cannabi indica intoxication, as 



Snnouncement. 327 

•experienced by himself, and immediately attributed my peculiar 
sensations and illusions to hemp in the Cuxe for Consumption, 

A medical journal published in India has recently made very 
free use of Dr. Wood's article in describing the effects of the 
'drug on its habitues, who, it claims, are becoming very numerous 
in that country. 



ANNOUNCEMENT. 

The committee on annual meeting selected by the executive 
committee of the Alumni association wish to report the following 
progress. 

1. Excursion rate. 

The railroads belonging to the Central Passanger Asso- 
ciation and the Western Passenger Association have granted a 
special excursion rate for the meeting of the Alumni association. 
It applies to all territory west of Pittsburg and Buffalo and 
reaches to the Pacific. Its southern boundary is the Ohio river. 
Any alumnus or friend of alumnus coming from within this 
territory can travel on this rate — any alumnus without this 
territory can purchase a ticket to some point within and then 
purchase a ticket to Chicago from the latter point. The method 
of procedure is as follows: Buy a ticket to Chicago paying full 
fare, at the same time asking for a certificate of purchase. 
Bring this certificate to the office of the secretary of the asso- 
ciation in the college building on Tuesday, April the 17th, and 
have it certified when you buy your ticket home you present 
this certificate, whereupon you are charged only one- third fare. 
This rate is contingent upon the presence of one hundred 
attendants where railroad fare has equalled seventy- five cents. 
Under this rate you can leave home any day from Thursday the 
12th to Tuesday the 17th. You can return any day from Tues- 
day 17th to Monday 23rd. It is hoped that many members of 
the association and their families and friends will come in time 
to witness the Easter observances in the city. 

2. Exercises: The Kneipe for the Alumni will occur at the 
Sherman House on Monday the 16th, at 7 P. M. The earlier 
part of the evening will be informal. The Alumni will be 
group 3 i in such a way as to permtt of the largest opportunity 
for good fellowship. Every alumnus is expected to come with a 
-s'lorl story, soug or speech. The .musicians are expected to 



77<e Plexus. 

bring their instruments and their music; a piano has been pro- 
vided. Later in the evening some professional talent will 
participate. There will be a short meeting of the association 
every morning from 9 to 10. This will be followed by a clinic 
from 10 to 12 A. M. ; on Tuesday from 12 to 1 P. M, we will have 
some refreshments in the college building. At 2 P. M. the 
graduating class have their class-day exercises. Tuesday night 
occurs the banquet given by the Faculty to the graduating class. 
On Wednesday night the graduating exercises occur. This is as 
much as the committe is ready to announce. It is hoped that we 
can arrange for other attractions. 

An alumnus arriving in the city should go to the college as 
soon as possible. Alumni head-quarters will be open the entire 
day — he will be put in touch with his friends and furnished a 
program of all Alumni and College exercises and all clinics to be 
held in the city during the period of his stay. 

3. Reunions: It is the custom in most schools to have a 
reunion of the class which has been out just ten years. Effort 
will be made to get together the largest possible number of the 
graduates of 1890. Dr. Doepp is now exerting himself in that 
direction; this means that an alumnus of 1890 can come to the 
exercises expecting to meet a considerable number of his class- 
mates This does not mean that eifort will not be made to secure 
the attendance of classmates of graduates of other years. 

4. Expenses: The Faculty has appropriated $250 to the 
entertainment of the Alumni — this will furnish enough money to 
allow considerable pleasure with a small amount of personal 
expense. 

[Signed.] L. H. Mitchell, 
E. A. Gansel, 
W. A. Evans, Committe. 



ABSTRACT OF THE GROSS ANATOMY OF THE 

ABDOMINAL PART OF THE ALIMENTARY 

CANAL. 

By W. T. Eckley, M. D. 

The abdominal part of the alimentary canal includes: 
1. The stomach. 
:2. The small intestine, from 16 to 24 feet long includes: 

The duodenum, about 10 inches in length. 

The jejunum, about H feet in length. 

The ileum, about 12 feet in length. 

3. The large intestine, 4 to 5 feet in length includes: 
The appendix, from 3 to 6 inches in length. 

The cacum, about 25 inches in length. 
The ascending colon, variable in length. 
The transverse colon, about 2 feet long. 
The descending colon, about 12 inches long. 
The sigmoid, variable in length. 
The rectum, about 6 inches long. 

4. The liver, a compound tubular gland. 

5. The pancreas a compound racemose gland. 

6. Tlae spleen, an accessory blood gland. 

The abdominal part of the alimentary canal begins at the 
esophageal opening in the diaphragm, and ends at the external 
sphincter ani muscle in the ischio- rectal part of the general 
pelvic outlet. The terminal opening is called the anus. 

The abdominal part of the alimentary canal in the embryo, 
consists of a straight gut- tube, in the midline of the posterior 
abdominal walls, located behind a layer of general dorsal peri- 
toneum. This primitive canal is nourished by three arteries 
which later are known as gastric, superior mesenteric and 
inferior mesenteric. 

In the embryo, the primitive straight tube, growing up 
behind, and pushing forwards the peritoneum, is so far removed 
in appearance and location, from the adult type, as to make its 
recognition a matter of most interesting embryological and 
morphological study. 



330 The Plexus. 

In our study of the alimentary canal, we must bear in mind 
two unequal growths; 1, the rapid growth of the underlying gut- 
tube: -, the slow growth of the overlying peritoneum. As a 
natural sequence of this unequal growth, the straight tube is con- 
voluted in some places and when the limits of its growth shall have 
been reached, certain parts will have been robbed of their 
primitive peritoneal covering. 

THE STOMACH. 

Location : in the left hypochondrium and epigastrium. 

Special character of the stomach: great mobility 

Most fixed part: the cardiac orifice end. 

Position when empty: under liver, in front of pancreas. 

Position when distended: forward and to the left. 

Size: length 1:2 inches, width 5 inches. 

Distance between orifices: from 3 to 6 inches. 

Capacity, average: 5 pints, average weight 5 ounces. 

Great cul de sac, location: at cardiac end. 

Small cul de sac, location: at pyloric end. 
• Cardiac orifice, location: 3 inches from left end. 

Pyloric orifice, location: at extreme right end. 

Pylorus, structure: mucosa and circular muscular fibres. 

Pyloric opening, diameter: one-half inch. 

Cardiac orifice, character: funnel like, upward. 

Upper border, length of: 3 to 5 inches. 

Lower border, length of: 12 to 20 inches. 

Borders, location of: between the orifices. 

Surfaces, location of: between the borders. 
- Surfaces, names of after rotation: anterior and posterior. 

Surfaces, names of before rotation: right and left. 

Surfaces, comparative size of: equal. 

Cardiac orifice, relation of to heart: above and behind apex. 

Peritoneal investment: practically complete. 

Non-f)eritoneal area: at the curvatures. 
Gastro-phrenic ligament, location: left of esophagus. 
Lesser omentum: between stomach and liver. 
• Greater omentum: between stomach and colon. 

Gastrb-sphenic omentum: between stomach and spleen. 

Coats: serous, muscular, submucous, mucous. 

Nerves: sympathetic via solar plexus and pneumogastric. 



Alimentary Canal. 331 

Pneumogastric, right, location of: on posterior surface. 
Pneumogastric, left, location of: on anterior surface. 
Arteries: supplying the stomach: 

1. Gastric, from the coeliac axis of the aorta. 

2. Pyloric, a branch of the hepatic. 

.3. Gastro-apiploica dextra, braiieh of gasto-duodenal. 

4. Gastro-epiploica sinistra, branch of the splenic artery. 

5. Gastro-duodenal, a branch of the hepatic artery. 

6. Vasa brevia, branches of the splenic artery, 

RELATION OF BRANCHES COELIAC AXIS IN THE EMBRYO. 

The student should remember the primitive relation of liver, 
stomach, spleen and pancreas. The liver lay in the anterior 
meso-gaster, the spleen and pancreas in the posterior— the 
coeliac axis gave off three large arteries for these four organs. 
1, the gastric which passed forward to reach the anterior border 
of the stomach; 2, the hepatic, which passed beyond the stom- 
ach, between the two layers, right and left, of the gastro- 
hepatic omentum, to reach the liver; 3, the splenic, which passed 
backwards between the two layers of the posterior meso-gaster, 
to reach the spleen and pancreas. 

GENERAL RELATIONS OF THE STOMACH. 

Above: Liver, lesser omentum and diaphragm. 

Below: transverse colon and great omentum. 

Front: the abdominal walls, and peritoneum. 

Pyloric end: gall bladder and under part of liver. 

Cardiac end: spleen and gastro- splenic omentum. 
i Greater omentum: gastro colic omentum. 

Lesser omentum: gastro-hepatic omentum. 

Cardiac end is continuous with the esophagus. 

Pyloric end is continuous with the duodenum. 

Behind: pancreas, crura of diaphragm, transverse meso- 
colon, solar plexus, spleen, left kidney, left adrenal, aorta, 
ascending vena cava. 

Embryology: up to the third month of fetal life, the stomach 
is a dilatation with its long axis parallel with the vertabral 
column. During the third month it rotates from left to right, 
thus making the left surface anterior and the right posterior; it 
also rotates transversely, thus bringing the pylorus to the right 
side and the cardia to the left. This double rotation accounts for 



332 ne Plexus. 

the presence, in the adult, of the left vagus nerve on the 
anterior and the right on the posterior surface of the stomach. 

Reflex phenomena in cancer of stomach and gastric ulcer, 
may occur as somatic pain in the abdominal walls — "epigastric 
tenderness" in gastric ulcer — or the lower shoulder region, 
because the stomach is supplied by the solar plexus, and the 
somatic correspondence of this plexus is from the sixth to the 
tenth spinal nerves. 

THE DUODENUM. 

Class: the first 8 or 10 inches of the small intestine. 

Extent: from pylorus to left side of second lumbar vertebra. 

Size: diameter, 2 inches; length, 8 to 10 inches. 

Comparative fixity: the most fixed part of small intestine. 

Comparative diameter: widest part of small intestine. 

Morphologic antecedent: end of embryonic foregut. 

General relation to transverse colon, behind. 

Retro- colic position due to: rotation from left to right. 

General relation to the pancreas: curves around. 

Parts: ascending, descending, transverse, second ascending. 

Arteries: pancreatico-duodcnal, superior and inferior. 

ASCENDING PORTION OF DUODENUM. 

Extent: from pylorus to neck of gall-bladder; 2 inches long. 
Direction, it passes upwards and backwards to the right. 
General character: very freely movable. 
Anterior peritoneal investment, covered in front. 
Posterior peritoneal investment: near the pylorus. 
Relation to foramen of Wins low and pancreas: above. 
Relation to hepatic root-structures: in front of. 
Hepatic root-structures: bile duct, portal vein, hepatic artery. 

DESCENDING PORTION OF DUODENUM. 

Extent: from neck of gall-bladder to third lumbar^vertebra; 
Direction: passes downwards, and curves to left. 
General character: more fixed than the asceading]portion. 
Peritoneal investment: covered in front only. 
Derivation of peritoneum: superior transverse meso-colon. 
Relation to transverse colon and its meso-colon: behind. 
Relation to pancreas: to right of head of pancreas. 
Ralation to vena cava, right kidney, and vessels: in front. 
Relation to common bile duct: duct pierces back part of. 



Alimentary Canal. 333 

Relation to pancreatic duct: duct pierces back part of. 

TRANSVERSE PORTION OF DUODENUM. 

Extent: from right of body of third lumbar across spine. 
Direction: it passes obliquely upwards and to the left. 
General character: the longest and most fixed part. 
Peritoneal investment; covered in front only. 
Relation to transverse meso-colon: behind. 
Relation to superior mesenteric vessels: behind. 
Relation to inferior pancreatico-duodenal artery, below. 
Relation to pancreas and superior mesenteric artery: below. 
Relation to vena cava, aorta and crura of diaphragm: in front. 

SECOND ASCENDING PORTION OF DUODENUM. 

Extent: from side of third vertebra upwards about 1 inch. 

Peritoneal investment; covered in front; sides partially. 

Relation to left crus of diaphragm; attached to the crus. 

Name of attachment: musculus suspensdrius duodeni. 

Fossa duodeno-jejunalis: to left of duodenum. 

Importance of this fossa: in retro-peritoneal hernia. 

Capacity of this fossa: one inch deep; one-half inch wide. 
Embrj^ology: At an early period the duodenum had a dorsal 
mesentery. Subsequently, with rotation of the stomach, it lost 
its mesentery by fusion with the posterior abdominal wall and 
became fixed. The transverse meso-colon fused with the perito- 
neum of the ventral surface of a part of the duodenum. 

Reflex phenomena in duodenal ulcer may occur as somatic 
pain, in the right hypochondrium and lower shoulder region, 
because the nerve supply of the duodenum is from the solar 
plexus, and this plexus has its somatic correspondence in the 
spinal nerves from the sixth to the tenth thoracic. 

JEJUNUM AND ILEUM. 

The upper two-fifths of the small intestine, counting from 
the end of the duodenum, is called jejunum. It is about 8 feet 
long, and always more or less empty, hence the name, intestinum 
jejunum. The diameter of the jejunum exceeds that of the ileum 
by one-half inch, its walls are thicker, its mucous membrane more 
complex and its blood supply more abundant. Surgical repair on 
the jejunum proceeds more rapidly than on the ileum; strangu. 
lated hernia of the ileum, on the other hand, is less dangerous 
than that of the jejunum.' 



334 The Plexus. 

The mesentery of the jejunum and ileum extends from the 
duodenum to the ileo-cecal region. The upper layer of the mes- 
entery is, for reasons comprehensible only when rotation is 
understood, continuous with the under layer of the transverse 
meso-colon and with the peritoneum of the ascending colon; the 
lower layer is continuous with the peritoneum of the descending 
colon and sigmoid. 

The coats of the jejunum and ileum are serous, muscular? 
submucous and mucous. The serous or peritoneal coat is on the 
outside and may be easily studied. The mucous coat is thrown 
into folds called valvulae conniventes, and can only be seen when 
the gut is opened and cleansed. 

The blood supply of the small intestine now under con- 
sideration is from the superior mesenteric artery. The 
arteries are accompanied by veins which ultimately reach the 
portal vein. The arteries are supplied with sympathetic nerves 
from the superior mesenteric plexus. The intestine with all its 
accessories is between two layers of peritoneum called'mesentery. 

Meckel's diverticulum is occasionally found, attached to the 
ileum, from 1 to 3 feet from the ileo-cecal junction. It is most 
frequently met as a blind tube from one to several inches in 
length. It may be the cause of congenital fecal fistula, to appre- 
ciate which the student should recall the following bit of embry- 
ology: The early gut- tube was connected to the umbilical vesicle 
by the vitelline duct. During the sixth week the vitelline vesicle 
begins to lose its usefulness, and die. The duct is attached to 
the ileum near the ileo- cecal region. The duct may do one of 
three things: 1, become obliterated; 2, remain a cul-de-sac; 3, 
remain patent, connecting the interior of the ileum, via the um- 
bilical aperture, with the external world. 

THE LARGE INTESTINE. 

The large intestine, whose arbitrary subdivisions will pres 
ently be described, dates its inception from the sixth week of 
intrauterine life, at which time a previously straight gut uniform 
in texture differentiates, at a point known as the ileo-cecal region, 
into large and small intestine. 

In the adult the large intestine extends from the ileo-cecal 
region to the anus. The ileo-cecal region is in the iliac fossa on 
the iliopsoas muscle. The large intestine almost completely 



Alimentary Canal. 335 

surrounds the small intestine, except the duodenum. For prac- 
tical purposes, in anatomy and surgery, we distinguish large from 
small intestine, by the presence, in large intestine, of the three 
following structures, which will be now described. 

DIFFERENTIAL FEATURES. 

1. Three longitudinal bands of muscular fibers. 

2. Certain sacculations produced by the longitudinal bands. 

3. Certain fatty masses, called appendices epiploicse. 

The function of the appendages of fatty masses is not known. 
The sacculations are variable in size in different specimens. As 
will be explained when the part is dissected, the gut must be 
inflated to appreciate the appearance of the sacculations. 

The three longitudinal bands radiate from the appendix and 
are lost on the rectum, these two extremes being the only parts 
of the large intestine in which these longitudinal bands are not 
present. The bands are equidistant from one another. If the 
circumference of the gut is 9 inches, the bands will be 3 inches 
apart. 

The longitudinal bands are named and located as follows: 

1. Posterior: on the attached border of the intestine. 

2. Inner: on lower of transverse inner part of remainder. 

3. Anterior: on the front part of the intestine. 

The surgical importance of the longitudinal Dands, and also 
the importance in dissection, is a guide to locating the appendix. 
As these bands radiate from the appendix the converse is true: 
any one band followed towards the right iliac fossa will lead to 
the appendix. The appendix is not always readily found by the 
student or operator. 

THE CECUM — CAPUT COLI. 

This is the initial end of the large intestine and is a part of 
the ascending colon. It is situated below the entrance of the 
ileum into the large intestine. It is about 2,5 inches long, and 3 
inches in diameter. In the majority of cases, the apex of the 
cecum rests on the psoas muscle. The cecum may be wholly in 
the true pelvis, or in cases of faulty rotation, which are rare, it 
may be on the left of the midline of the posterior abdominal 
walls. For morphological .reasons, which will be appreciated 
when you study rotation of the intestinal tube, the cecum pre- 
sents the following four types in the adult: 



336 The Plexus. 

1. The infantile, conical; appendix at the apex. 

2. The quadrilateral; appendix between two bulging sacculi. 

3. Right caput undeveloped; apex to left and behind. 

4. Left caput atrophied; no trace of apex. 

5. The cecum may be insignificant — microcecum. 

6. The cecum may be overgrown — macrocecum. 

7 . The ileum may pass behind colon and open on right side. 

8. The ileum may enter the front of the cecum. 

9. The cecum may be found just under the liver. 

10. The cecum may be found near the umbilicus. 

11. The primitive condition of common mesentery may obtain. 

THE VERMIFORM APPENDIX. 

This is attached to the cecum, near the ileocecal valve on 
the inner and posterior part. It varies from 3 to 6 inches in 
length. It is a hollow blind tube. It is usually behind the ileum. 
It may hang across the pelvic brim, or lie vertically behind the 
cecum. It has a mesentery, derived from the left mesentery of 
the ileum. Its mesentery is triangular and has in its free margin 
the appendicular artery, a bn.nch of the ileo-colic. Like the 
major part of the alimentary canal, the tube grows faster than 
the peritoneal covering — the mesentery — hence the twisted con- 
dition of the organ. The tip of the appendix is lost in the abdo- 
men. At the time of its first appearance in the embryo, the 
appendix equals the cecum in size. 

The ilio-cecal valve is formed by a double fold of mucous 
membrane and circular muscular fibre at the junction of the 
small and large intestine. The valve is not a perfect one, as has 
been noted in clinical practice by ejection from the mouth, of sub- 
stances injected per rectum. The student should demonstrate in 
the dissecting-room the fact that water introduced into the as- 
cending colon near the liver will find its way quite readily into 
the small intestine. There is usually to be found at the begin- 
ning of the appendix a small valve formed by a fold of mucous 
membrane. 

SUBDIVISIONS OF THE LARGE INTESTINE. 

The large intestine has the following subdivisions: 
1. The ascending colon extends from the right iliac fossa to 
the lower margin of the right lobe of the liver. It begins in a blind 
pouch, the caecum, to which is appended the vermiform appendix. 



Al hnentary Canal. ^^* 

The ascending colon is variablein length, usually from four to six 
inches long. A very large liver or imperfect rotation may account 
for its shortness. It is held in position by the ascending meso- 
colon. The ascending colon may be absent, in which case the 
caecum belongs to the transverse colon. It is in relation with 
the right kidney, descending duodenum, and quadratus lumbor- 
um muscle. 

2. The transverse colon extends from the hepatic flexure to 
the splenic flexure of the colon, across the umbilical region trans- 
versely, makes a sharp bend downwards at the lower border of 
the spleen, called the splenic flexure. It is held in position by the 
transverse meso-colon. It is in relation above with the liver, 
gall-bladder and spleen; behind, with the 3rd part of the duode- 
nnm; below, with the small intestine; anteriorly with the abdom- 
inal walls. Its artery is the middle colic a branch of the super- 
ior mesenteric artery. 

3. The descending colon extends from the splenic flexure to 
the sigmoid. It lies in the left hypochondriac and left lumbar 
regions. It is more movable than the ascending colon. Behind, 
it is related to the left kidney, diaphragm, and quadratus lum- 
borum muscle, while in front of it, lies the small intestine. The 
descending colon has, as a rule, no peritoneum postoriosly. In 
one hundred dissections, Morris found a distinct meso-colon in 
36 bodies. The descending colon receives its blood- supply from 
the inferior mesenteric artery. 

The sigmoid flexure begins in the left iliac fossa and ends op- 
posite the 3rd piece of the sacrum, where the mesentery ceases. 
From its resemblance to the Greek letter, the sigmoid is called 
the omega loop. The normal position of the omega loop is in 
the pelvis. As a rule the sigmoid will be found in contact with 
the bladder, and hidden from view by the small intestine. The 
sigmoid has a meso- sigmoid from one to four inches in length. 
The meso-sigmoid may be absent over the prousmagnus muscle. 
At the bifurcation of the common iliac vessels, is often found the 
intersigmoid fossa, the seat of sigmoid hernia. This fossa is less 
than two inches deep, and formed, funnelshaped, by the sigmoid 
artery and folds of the meso sigmoid. The sigmoid is supplied 
with blood by the sigmoid artery, a branch of the inferior mes- 
enteric. 

The rectum extends from the 3rd piece of the sacrum to the 



338 The Phxut. 

anus. It consists of 1, an upper segment, which ends at the tip 
of the coccyx; 2, a lower segment which ends at the anus. 
The upper segment is 3.5 inches long, and covered by peritoneum 
above and in front only. It is in relation behind, with the sympathe- 
tic nerve, sacrum and coccyx; in front, with the prostate body, 
the vesiculae seminales and trigonl. In the female, the anterior 
surface of this part of the rectum is in relation with the upper 
part of the vagina and cervix uteri. The rectum just above the 
anus is much dilated. 

The lower segment of the rectum is about 1.5 inches long. It 
is not covered by peritoneum. The levator ani muscle is at- 
tached to it. It is surrounded by the internal sphincter muscle 
below the prostate. The external sphincter is at its end. The 
blood- supply of tlie rectum is as follows: 

1. Superior hemorrhoidal, inferior mesenteric artery. 

2. Middle hemorrhoidal, from the internal iliac artery. 

3. Inferior hemorrhoidal, from the internal puclic. 

4. Vessels are longitudinal in lower part of rectum. 

5. They communicate freely near the anus. 

6. There are two systems of veins in the rectum. 

7. The portal system joins the mesenteric veins. 

8. The iliac system joins the internal iliac veins. 

9. The veins are longitudinal in the lower part of the rec- 
tum, where they communicate freely, forming the hemorrhoidal 
plexus of veins. 

The anus is the terminal opening, by which the rectum per- 
formes its extrusive function. The corrugator curtis ani, the ex- 
ternal sphincter ani, and the levator ani are important accessory 
muscles. One muscle remains to be described in this place, the 
internal sphincter ani. This muscle is produced by a thickening 
of the circular muscular fibres of the rectum, for about one half 
inch in extent. It is located about an inch above the anus, where 
it forms a complete muscular ring. 

THE LIVER, 

Location: epigastric, right and left hypochondriac regions. 

Weight: about 5 pounds in the male; less in the female. 

Displacement capacity: 95 cubic inches. 

Specific character: firm, solid, friable, chocolate color. 

Borders, two: anterior and posterior. 

Extremities, two: right and left. 



Alimentary Canal. 339 

Surfaces, three: superior, inferior and posterior. 

Lobes, five: right, left, caudate, quadrate, Spigelian. 

Fissures, five: cystic, caval, transverse, umbilical, ductus 

Ligaments, five: broad, round, coronary, lateral. 

The root structures of the liver are those nerves and con- 
duits that enter the organ through the transverse fissure. On 
entering, they are between an anterior and posterior layer of les- 
ser omentum. They are supported by connective tissue, known 
as the capsule of Glisson. The structures and their uses are as 
follows: 

1. The left vagus nerve filaments, and sympathetic nerves 
from the solar plexus. These nerves accompany the vessels, 
under the name of hepatic plexus and confer on the liver sensa- 
tion, resiliency and trophic qualities. 

2. The hepatic artery, a branch of the coeliac axis of the 
aorta, divides into right and left lobe-branches. The artery lies 
to the left of the common bile duct, and anterior to the portal vein. 
It furnishes the liver and gall bladder with nutrition. 

3. The portal vein is about 3 inches long. It is made up be- 
hind the head of the pancreas, by the confluence of the splenic 
and superior mesenteric veins. In the transverse fissure, the 
vein dilates to form the portal sinus; it then divides into a right 
and a left branch to enter the liver. The portal vein, in its pas- 
sage to the liver, lies behind and between the hepatic artery and 
common bile duct. The tributaries of the portal vein are the 
gastric, cystic, splenic and superior mesenteric. The inferior 
mesenteric vein is tributary to the splenic vein. The portal vein 
begins in capillaries in the spleen and abdominal digestive organs, 
and ends in capillaries in the liver. In the liver the portal vein 
receives capillaries corresponding to the distribution of the he- 
patic artery, and leaves the liver, on the posterior surface of the 
organ discharging into the ascending vena cava, under the name 
of venae cavae hepaticae. 

4. The right and left hepatic ducts unite to form a common 
hepatic duct; this duct unites with the cystic to form the com- 
mon bile duct. 

As previously stated, the hepatic artery is the nutrient 
artery of the liver. The blood in the portal vein, coming from the 
digestive organs, contains glycogen and bile products; the former 



340 The Plexus. 

is stored up for future use, the latter are conveyed to the gall 
bladder via the hepatic and cystic ducts. 

The anterior border of the liver is a sharp thin edge. At the 
beginning of the longitudinal fissure is the inter-lobar notch, 
which divides the right lobe from the left. This border is freely 
movable. The posterior border is thick, rounded, fixed and 
notched, for the ascending vena cava and the vertebral 
column. 

The superior surface is divided into right and left lobes by 
the suspensory ligament, a remnant of the anterior mesogaster. 
On the left lobe may be seen a depression for the heart. This 
whole surface is moulded to the concave surface of the diaphragm. 

The inferior surface of the liver Includes the transverse fis- 
sure and the part in front of this fissure. The parts of this sur- 
face not covered by peritoneum are: (1). The fissure for the 
gall bladder; (2) the space between the two layers of lesser omen- 
tum. On this surface may be seen: 1. The longitudinal fissure, 
which contains the umbilical vein in the foetus; it is for this reason 
called the umbilical fissure. In the adult the umbilical fissure 
contains the round ligament of the liver — the obliterated hypo- 
gastric vein. (2). The fissure for the gall bladder. (3). The 
transverse fissure, transmitting the portal vein, hepatic duct and 
hepatic artery. (4). The quadrate lobe, between the gall bladder 
and the umbilical fissure. (5). Contain more or less marked sur- 
faces, where adjacent organs impinge the liver, known as the 
impressio gastrica. impressio renalis, impressio coila, impressio 
duodenalis. 

The gall bladder. The gall bladder is just to the right of the 
quadrate lobe in the fissure for the gall bladder. It may be in- 
flated on the cadaver and will then touch the front wall of the 
abdomen, at the 9th costal cartilage, where it is accessible for 
operation. It is from 2.5 to 4 inches long, pyriform in shape and 
1.5 inches wide at the fundus, and holds about one ounce. The 
neck is at the transverse fissure of the liver. It has a right curve 
above and a left one below. The part of the gall bladder between 
the fundus and neck is the body. 

The gall ducts are: (1). The cystic duct which is but little 
more than the exhaustion of the pyriform gall bladder. It is 
about 1.5 inches long. It unites with the common hepatic to 
form the common bile duct. It lies in front of the portal vein, 



Alimentary Canal. 341 

and to the right of the hepatic artery. If this duct is obstructed, 
bile can neither escape from nor enter the gall bladder. 

The common hepatic duct is made up in the transverse fis- 
sure of the liver by the junction of the right and left hepatic 
ducts coining from the right and left lobes of the liver. It is 
about 1.5 inches long and unites with the cystic duct to form the 
common bile duct. If the duct is obstructed bile cannot escape 
from the liver. This duct crosses the hepatic artery and portal 
vein, to join the cystic. 

The common bile duct — ductus communis choledocus — is 
formed by the union of the cystic and common hepatic ducts. It 
is 3.5 inches long and \ inch in diameter. It lies between the 
two layers of the lesser omentum. Its course is: (1). Behind 
the first stages of the duodenum; (2) in front of the portal vein; 
(3) to the right of the hepatic artery; (4 to tl eft of the descend- 
ing duodenum; (5) behind the head of the pancreas; (6) behind 
the descending duodenum; it perforates the 2d part of the duod- 
enum, runs f of an inch in the walls of the duodenum, and unites 
with the pancreatic duct, forming a dilatation here — the ampulla 
of Vater. 

The posterior surface of the liver is that part behind the 
transverse fissure. On it are seen: (1) the Spigelian lobe located 
between the ascending vena cava and the fissure for the ductus 
venosus; (2) the ascending vena cava; (3) the fissure for the 
ductus venosus; (4) the tuber omentaie, a prominence on the left 
lobe which touches the lesser omentum. 

Emhryolociy. The liver is a compound tubular gland. Glands 
in general are formed by an ingrowth of the walls of the cavity 
to which they pertain. At an early period, the ventral wall of 
the gut, below the stomach gave birth to two diverticula, one 
was the future pancreatic duct, the other the common bile duct. 
In courseof time, the common bile duct evaginated two diverticula; 
one became the gall bladder, the other grew into the liver ridge, 
located in the future diaphragm, and evolved the liver. The 
liver owes its bile-duct epethelia, and proper hepatic cells to the 
ectodermic evagination; its connective tissue parts to the liver 
ridge. The liver consists of two elemental parts: (1). a duod- 
enal; (2) a diaphragmatic. In the embryo, the liver occupied a 
position between the two layers of the anterior meso-gaster, in 
front of the stomach. 



342 The Plexus. 

Reflex phenomena in biliary calculi, cancer of the liver, and 
suppurative hepatitis or many other diseases of the liver may occur 
as somatic pain in the right shoulder or abdominal walls, since 
the liver derives its nerve supply from the solar plexus, and the 
somatic correspondence of this plexus is in the spinal nerves from 
the 6th to the 10th thoracic. 

THE PANCREAS. 

Location: epigastrium and left hypochondriac regions. 
Physiological class: a compound racemose gland. 
Size: length, 7 inches; breadth, 1.5 inches; thick, ^ to 1 inch. 
Specific physical character: soft, pinkish, cream color. 
Divisions: head, neck, body, tail, excretory pancreatic duct. 
Head: embraced by descending and transverse duodenum. 
Shape of head: disc-shaped, and flattened. 
The neck is a slight constriction joining head and body. 
Surfaces of body: anterior, inferior and posterior. 
Peritoneum of anterior surface: transverse meso-colon. 
Anterior, visceral relation of : posterior surface of stomach. 
Anterior surface: concave by pressure of stomach. 
The posterior surface is in contact with the following: 

1. The crura of the diaphragam. 

2. The superior mesentric vessels, aorta, vena cava. 

3. The splenic artery and splenic vein. 

4. The left kidney and left adrenal. 

5. The commencement of the portal vein. 
The tail touches the inner surface of the spleen 
The pancreatic duct: synonym, duct of Wirsung. 
Duct, origin of: in the tail by smaller ducts. 
Duct, end of: in descending duodenum. 

Duct, relation of to common bile duct: may join same. 
Arteries: from splenic, hepatic and superior mesenteric. 
The veins open into the splenic and superior mesenteric. 

Embryology. The pancreas is produced by an evagination of 
the dorsal wall of the duodenum. In the early embryo, it lies 
behind the stomach, between the two layers of the posterior 
mesogaster, being of course completely invested by poritoneum. 
With rotation the pacnreas loses its mesentery and becomes a 
retro-peritoneal organ. The evagination of the duodenal wall 
previously referred to, meets embryonic connective tissue, / 



Alimentary Canal. 343 

the posterior mesogaster, and the result of the meeting is the for- 
mation of the pancreas. The pancreas has then embryologically 
two elements; 1, a duodenal; 2, embryonal connective tissue. 

THE SPLEEN, 

Physiological class: a great ductless blood. gland. 

Situation: deep in the left hypochondriac region. 

Location: between the fundus of stomach and diaphragm. 

Relation to ribs in axillary line: between 8th and 11th ribs. 

Organic character: bluish red, soft and easily torn. 

Shape: elliptical, with long axis parallel to line of 10th rib. 

Size: length 5, breadth 3.5, thickness 1.5 inches. 

Displacement capacity: 15 cubic inches. 

Surfaces: outer, convex; inner, concave. 

Inner surface divided by the hilum, a vertical slit. 

The hilum a vertical slit, transmit to the splenic vessels. 

Borders: anterior and posterior, upper and lower. 

Coats: 1. fibro-elastic capsule; 2. peritoneal covering. 

The splenic artery, a branch of the coeliac axis, is very 
large and tortuous, and enters the spleen by several branches. 
The arteries in the substance of the spleen are supported by the 
trabecular connective tissue derived from the fibro-capsule. The 
splenic artery lies above the splenic vein, and passes along the 
upper border of the pancreas, being partially concealed from 
view by this gland. The branches of the splenic artery are: 

1. Terminal, 5 to 8, distributed to the spleen pulp. 

2. Vasa brevia, to the greater cul de sac of the stomach. 

3. Left gastro-epiploic, anastomoses with the right. 

4. The large pancreatic, accompanies the pancreatic duct. 

5. Small pancreatic branches to the pancreas. 

The splenic veins begin as capillaries in the splenic pulp; 
they unite to form 4 or 5 veins, which come together before they 
reach the hilum, to form the splenic vein. The vein accompanies 
the artery, lying below the same, and becomes confluent with 
the superior mesenteric artery, behind the head of the pancreas 
to form the portal vein. In its course it receives the following 
veins: The inferior mesenteric vein, the left gastro-epiploic vein, 
the pancreatic veins, the vasa brevia veins. The nerve supply 
of the spleen is from the solar plexus. The nerves are called 
s plenic sympathetic and accompany the splenic artery. The 



344 The Plexus. 

spleen elaboi'ates the albuminous materials of the food, and stores 
them up for future use. 

Embryology: The spleen is not a digestive organ. In the em- 
bryo the spleen lies between the two layers of the posterior 
mesogaster near the pancreas. It is differentiated from the 
mesodermic tissue in this embryonal locality. The characteris- 
tic part of the spleen is called pulp, which is formed of nucle- 
ated cells along the branches of the arteries in the spleen. In 
addition to the ordinary one there may be several smaller spleens 
from 1 to 20 developed is the gastro- splenic or even in the gastro- 
colic omentum. 

Visceral relations: The external surface of the spleen is in 
relation with the diaphragm, and corresponds to the 9th, 10th, 
and 11th ribs. The internal surface is in relation with the car- 
diac end of the stomach, the tail of the pancreas, the left adrenal, 
the left crus of the diaphragm. The superior border is con- 
nected to the diaphragm by the suspensory ligament of the 
spleen. The inferior border is in relation with the splenic flex- 
ure of the colon. The posterior border is attached to the left 
kidney by connective tissue. The hilum is connected to the car- 
diac end of the stomach by the gastro-splenic omentum. 

Reflex phenomena, incident to disease of the spleen may oc- 
cur either in the vicinity of the left shoulder or in the left abdom- 
inal walls, as somatic pain, since this organ receives its nerve- 
supply from the solar plexus, and this plexus has its somatic cor- 
respondence in spinal nerves from the 6th to the 10th thoracic. 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT 
UNIVERSITY OF ILLINOIS. 

Editor, H C WADDLE, '03. Business Mgr. E. J. MERKI, '02. 



Class Editors: 

H. B. HAMILTON, 00. CH AS. M NOBLE, 01. PAUL E. GRABOW, 02. 
GUY C. WAUFLE, 03. 



Faculty Department, DR. W. A. PUSEY. Athletic Editor, A. DONKLE, '01 

Alumni Editor, DR. C. C. O'BYRNE, '94. Clinical Department, DR. A. E. GANSEL 



Publishers. ----- MERKI & WADDLE. 

Subscription $1.00 per Annum in advance. Single copies, 15 cents. Issued Monthly 
Send all remittances and communications as to subscriptions and advertising to E. J. 
MERKI, Business Manager, 813 W. Harrison St. 

Entered at Chicago Post Office as Second-Class Matter. 

Any subscriber desiring the Journal discontinued at the expiration of his subscription 
should so notify the Publishers; otherwise it will be assumed *hat the subscription is to be 
continued and the Journal sent accordingly. 

Contributions of matter suitable for publication are invited, and should be sent in not 
later than the 35th of the month previous to that of publication. The publishers willnot hold 
themselves responsible for the safe return of MSS. unless sufficient stamps areforwai'ded 



EDITORIAL 

On Feb. 1st, we sent out statements to our subscribers con- 
cerning their subscription and have heard from a comparatively 
few, and we desire to call the attention of those who have not re- 
sponded to the fact that, in order to keep our journal up to its 
present position, we must have the subscription price. Will those 
having received statements and have not responded, please do 
so at once, so that we may continue at our present rateV 

% * 

•» 

The student subscribers of the Plexus should not fail to 
leave their summer addresses at the Plexus office before leaving 
at the close of this term as the Plexus will be published each 
month during the year. Do not fail to do this. Other subscribers 



346 The Plexus. 

will save us a great deal of trouble at times if they will keep us 
informed of change of address. 



The April issue of the Plexus will contain a Table of Con- 
tents of the fifth volume of the Plexus, which will be the first 
issued by the Plexus, and will, we hope, be well received by 
those who desire to have their Plexus bound. 

We also desire to call your attention to the bindery found 
among our advertisers 

* 
The seniors will find it to their advantage to read our adver- 
tisements and enter into communication with our advertisers as 
they are all res^Donsible parties and will treat you well. Please 
mention the Plexus when writing. 

■35- 

In this issue of the Plexus, will be found a "Plexus Ex- 
change'" which we hope will be of much usefulness to our readers. 
If you have anything for sale or want anything, give us a chance 
to help you out. 

* 
The April issue will be devoted entirely to the Seniors and 
the Alumni and we are planning to get out a souvenier number 
which will contain among other things, the following: Picture of 
faculty, of the class, class history, class valedictory, eccentrici- 
ties of faculty, of class, calender, advice to D. J's. and write up 
of all organizations connected with the College of Physicians & 
Surgeons. 

There is in Chicago an organization known as the University 
of Illinois Club of Chicago. This club, if we are correctly 
informed, is for the Alumni of the University of Illinois, but it is 
an organization which the controlling part seems to be a part of 
the Alumni only as the officers, trustees, etc., seem to be selected 
from that part of the University located at Champaign, 111. At 
the same time the Alumni of the College of Medicine and Pharm- 
acy receive quite regularly an invitation to their annual meeting, 
with a §2.50 assessment attached. If the controlling spirits of 
this organization expect to have the support of the Alumni of 



Editorial. 347 

the College of Medicine — there will have to be a change in 
tactics, as at present it seems to be "taxation without represen- 
tation." 

* * 
* 

Dr. E. H. Lee, the author of the leading article in this issue 
of the Plexus, is a graduate of the University of Wurzburg, 
Bavaria, in the class of 1892. For one and one-half years after 
his graduation, he served as interne in the Julius Hospital in 
Wurzburg. He became assistant to Dr. J. B. Murphy in May, 
1893 and yet holds that position. For the past two years Dr. 
Lee has held fracture clinics at the Cook County Hospital which 
have been very popular with the P. & S. students. 

He is Professor of Surgery at Chicago Clinical School and is 
on the staff at Cook County, West Side and Alexian Brothers' 
Hospital. 

Dr. Lee is fast becoming recognized as authority on frac- 
tures. 

* * 

Dr. Geo. F. Butler, Ph. G., Professor of Materia Medica and 
Clinical Medicine, College of Physicians and Surgeons, editor of 
Doctors'' Magazine, has been appointed to the superintendency of 
the Alma Sanitarium and has severed his connection with the 
Cook County Hospital, but still holds his chair in the P. & S. 
College. 

We predict a boom for the Alma Sanitarium and the trustees 
are to be congratulated in securing so well equipped man as Dr. 
Butler for their superintendent. 

Dr. C. C. O'Byrne, the Alumni editor of the Plexus, hag 
been appointed to take Dr. Butler's place on Cook County staff 

Dr.J.C. O'Day, the author of one of the leading articles of this 
issue, is a graduate of the medical department of the Ohio Uni- 
versity of the class of '96 and after practicing for three years has 
■ done post-graduate work in the College of Physicians and Sur- 
geons here during the past year and is a member of this year's 

graduating class. 

* * 

The attention of the Alumni and of the students is called to 
the announcement of the reception committe on another page. 



348 The Plexus. 

It is quite evident that the alumni have no intention that old 
acquaintance shall not be forgotten. Attention is called to the 
excursion rate. This rate is not to be operative unless one 
hundred take advantage of it. As it is open to all Alunai, (now 
niunbering over 1,000) to all students (nearer a thousand than 
they used to be) and to all friends of Alumni, and of students 
there ought not to be danger of less than one hundred applying 
for it. You are to remember that the certificate must be asked for 
at the time of buying your ticket at your home and that this 
certificate must be O.K. at the College on Tuesday. If you will 
notice we call the attention of our embryonic fellows as well as 
the old dogs to this notice — and why— because we want every 
student to know that to graduate from the school means some- 
thing. That on graduating they are to take their places in a 
cohesive body standing together for mutual advancement ready 
to hurl their forces against any fellow who dares poach on their 
preserves and may be to sneak a few of the other fellows pre- 
serves. The attention of the Alumni is called because there is 
necessity for greater cohesion and there will be reward for 
greater cohesion. The financial support of the college is recog- 
nition of the fact that the college needs th(=> Alumni. A search 
of the role of preceptors of the the student body furnishes proof 
that the Alumni recognizes that they need the school. There is 
no question but that every Alumnus ought to come to this meet- 
ing. That's his duty — but as Kipling says, ''That's another 
story." There's going to be a rattling good time, there's going 
to be some fellows here that you haven't seen in a long time. 
There's going to be some bald headed boys — some juvenile papas. 
The disgruntled, the sour, the uncompromising bachelors will 
be given a chance to see the sweet girl graduates. All wiJl be 
lovely and the goose will hang high, so come along. 



COLLATERAL BLOOD CIRCULATION AND PNEU- 
MATIC TREATMENT. 
Arthut F. Klinetop, M. D. 

Collateral circulation of the blood in the tissues and various 
organs of the human body, as effected by anastomotic distribu 
tion of the blood vessels, is a marvelous natural provision against 
gangrenous processes inevitable consequent where the supply of 
blood is completely prevented. 

The increased capacity of collateral branches is demonstrated 
by the continuance of the processes of nutrition in parts from which 
the blood supply has been cut off from blood vessels in the direct 
line of supply from the heart, which have become obstructed or 
completely occlueded. The expansive capacity of the collateral 
blood vessels due to their natural elasticity, enables them to 
carry the normal quantity of blood as substitutes for the in- 
capacitated arteries and veins. 

In those divisions of the vessels obstructed or occluded, there 
is more or less stagnation of blood, and this accounts for many 
local disturbances and diseases caused by deposits from the blood 
and the generation of autotoxines in the circulation. 

When the nitrogenous equilibrim is interfered with, the sur- 
plus is prone to dejDosit from the blood current retarded in ves- 
sels obstructed from various causes, a potent one of which is 
local congestion due to sudden impressions of cold. 

Thus urates are deposited locally and give rise to inflamma- 
tory conditions characteristic of gouty and rheumatic diatheses. 

Aside from special dietetic regulations calculated to aug- 
ment oxidation and favor metabolism, together with the admin- 
istering of such remedial agents as conduce to the disorganiza- 
tion of superfluous nitrogenous products, it has been demon- 
strated that there is no method in vogue so efficacious in restor- 
ing the normal local circulation of the blood as that of pneumatic 
or vacuum treatment. 

The results of this treatment, applied with the facilities of 
modern apparatus, are truly surprising. 

In all affections caused by deposit in the muscles or tissues 



350 The Plexus. 

which enter into the mechanism of articulations, as well as in 
vascular disturbances in special organs, as of the liver, kidneys, 
etc-, the vacuum method is now an indispensable adjunct to suc- 
cessful treatment. 

A few treatments of this nature in lumbago, muscular rheu- 
matism, chronic articular rheumatism, and in all conditions char- 
acterized by local subacute inflammation, in addition to careful 
observance of indications and adaptation of scientific therapeu- 
tics directed to the re-establishment of the proper physiological 
equipoise, are almost invariably followed by immediate relief of 
distressing symptomatic manifestations, and are found to materi- 
ally assist in cure. 

The encouragement of collateral circulation and there-estab- 
lishment of the blood current through partially occluded blood 
vessels, are unquestioned results of this treatment. 

The equipment for the successful administering of pni u- 
matic treatment is more complex than is ordinarily supposed. 

It has been my fad, if it may be so called, to go to the limit 
in this respect, and it has been a source of pleasure to be able to 
assist other physicians in the management of obstinate chronic 
cases of rheumatism, neuralgia, spinal congestions, and various 
conditions in which local subacute inflammations and disturb- 
ances are occasioned by localized interference with circulation 
and the processes of nutrition. 

H. J., restauranter, age 43, weight about 200 lbs, alt. 5 ft. 
10^ inches, good physique, and robust from childhood, past life 
an exciting and rather luxurious one, patient of Dr. D., sent to 
me for pneumatie treatment. 

For several years "suffered with backache", a peculiarity in 
the case being that no pain was ever experienced except after 
being in bed several hours. 

For several years the period of rest and sleep at night was 
limited to three or four hours, after which patient was compelled 
to arise on account of pains in the muscles of the loins and back, 
which invariably disappeared after moving about or sitting up- 
right for fifteen or twenty minutes, showing that special muscles 
involved in th)3 uric acid deposits and tender as the result of sub- 
acute inflammatory processes consequent, were effected by posi- 
tion and impeded local blood circulation. 



Pneumatic Treatment. 351 

Various treatments given to reduce the acidity of the urine 
and dietetic regulations to balance the nitrogenous elements in 
the system in harmony with health, together with turkish baths, 
massage and the use of static and other forms of electricity, were - 
of no avail. Despite every treatment, he could not sleep after a 
few hours in bed and was always compelled to arise before in- 
clined to do so. 

Four weeks' treatment of the entire dorsal and lumbar regions 
and along the spine effected in this case a permanent cure, a re- 
port from the patient's regular medical advisor several months 
ago having been received by me to this effect. 

Space permitting, I could cite numerous instances in which 
the vacuum treatment has accomplished some of the most happy 
results. 



CLINICAL DEPARTMENT. 
E. A. Gansel. 



Prof. Newman is taking a vacation trip through Mexico. 
Since his absence Prof. Byford has been conducting some very 
interesting gynecological clinics. 

Prof. Harsha has returned from his trip to Arkansas. 
During his absence Prof. O'Byrne conducted several interesting 
surgical clinics. 

Prof. Steele and Prof. A. H. Ferguson of the South Side Post 
Graduate Medical School, operated on a very diiiicult case of 
cleft palate on February 26th on a man 23 years of age. The 
case was a very interesting one for besides above deformity 
there was a complete harelip, and both hands and both feet 
deformed by missing digits. Each hand was short an index 
and middle finger, while each foot had only the great toe and the 
two small toes, the latter being grown together. The operation 
presented many difficulties and although most of us will be 
rather slow in ourselves trying to remedy such severe defects it 
showed what can be accomplished by skill and careful work. 
A week later Prof. Steele corrected the harelip and both 
operations have given very gratifying results. 

We most heartily congratulate Prof. Butler on his good 
fortune in receiving the appointment of Medical Superintendent 
of the Alma (Mich.) Sanitarium. We can at the same time 



352 The Plexus. 

congratulate the Sanitarium upon securing so able a man to fill 
the position, for Prof. Butler's work as a teacher at P. & S., his 
clinical lectures at Cook Co. Hospital, his articles and advanced 
ideas on therapeutics which brought to him the appointment as 
chairman of the committee which is to prepare the next United 
States Pharmacopeia, and his initial number of The Doctors' 
Magazine all go to prove his ability not only as a physician but 
also as a speaker, writer and business manager. We understand 
that Prof. Butler intends to retain his connection with the 
College of P. & S. and also continue to publish his magazine, 
though he has been obliged to give up his clinical lectures at 
Cook County Hospital. 

Prof. Goodkind has made some variation in his clinical 
course on General Diagnosis for the last six weeks of the course. 
The class is now divided into sections of twenty-five and all are 
given the opportunity to examine cases carefully and make 
diagnoses with the assistance of Prof. Goodkind. This is 
proving very satisfactory for he always has a large number of 
cases, more than he could handle under his former system while 
now these cases are utilized and the most interesting and profit- 
able of them are carefully demonstrated to the section as a 
whole. 

Prof. Quine has joined the staff of attending physicians at 
Cook County Hospital and will hereafter conduct a medical clinic 
on Thursdays from eleven to twelve o'clock. His first clinic was 
held March 8th, when he presented a case of carcinoma of the 
liver in that very systematic and definite manner so character- 
istic of all of Prof. Quine's work. He had the history read, 
emphasized the important symptoms, made a concise diagnosis 
by exclusion of all the diseases in which an enlarged liver occurs, 
explaining in a few words how he excluded each one as he took 
it up, then stated the positive i)oints which assured him that the 
man was suffering from carcinoma and concluded by giving the 
morbid anatomy, prognosis and treatment of the case. 

Prof. Quine's many duties in connection with the College of 
P. & S. mean a very considerable financial loss to him and this 
new undertaking will require still more energy from a man who 
is already doing far more than an average amount of work. We 
can, however, fully assure him that all P. & S, students and 
alumni are most highly pleased with this new addition to our 



Carcinoma of the Lip. 353 

course while the classes to follow are certainly to be congratu- 
lated upon^the fact that the authorities of this college are 
determined to anake iheir clinical courses second to none in 
Chicago. 

OPERATION FOR CARCINOMA OF THE LIP BY PROF. MURPHY. 
Family Hsitory: Negative. 
r Personal History: Male aged 36 years. Machinist. Has had 



the diseases of childhood. In 1888 had malarial fever for 
thirteen ^j weeks. Smokes, chews and drinks considerably. 
Venereal history negative. (Used to smoke a claj^ pipe a great 
deal.) General health always good. 

Present Troultle: In 1894 
fell and injured the lower lip 
by striking on teeth. Ever 
since then the lip has always 
been open slightly. Last 
spring the ulceration began 
to increase and the lip became 
a little swollen. Since last 
New Year lip has increased 
very much in size. The ulcer- 
ation was first present at the 
left angle of the mouth but 
now involves almost entire lip. 
Is not very painful. Surface 
bleeds at times especially on 
slight traumatism. No loss in 
weight, appetite good, bowels 
regular no urinary symptoms, 
no lung symptoms. 
Steps in Operation: 
1. Surgical preparation of 
parts. 

1\ Carcinomatous portion of lip excised completely includ- 
ing one-fourth inch into healthy tissue. Hemorrhage partly con- 
trolled by clamps outside line of iacision laterally. 

3. After hemorrhage had been entirely checked the defect 
was filled in as follows: 

4 . Two flaps of mucous membrane were made from inner 




Rtsult two weeks after operation. 



354 The Plexus. 

sides of cheeks, one on each side, extending laterally from 
lateral margins of defect, the pedicles being attached at the 
latter situations. Each flap of mucous membrane was about one 
and one-half inches long and one-half inch wide. They included 
only the thickness of the membrane. 

5. Flaps of mucous membrane twisted inward, bringing 
their free ends into apposition with each other, thus forming a 
new mucous membrane, covering over the defect. Flaps were 
sutured to each other in the median line, where they were in 
apposition, by means of a few fine horse- hair sutures. The 
lower edge of the new formed strip of mucous membrane was 
now sutured to the cut edge of the mucous membrane of the 
ah^eolar process where the latter was divided in removing the 
diseased portion of the lip. The sutures were of fine horse-hair 
placed close together and tied so that the knots would be in the 
mouth. 

6. Defects in the mucous membrane on each side, left by 
removal of flaps, were now closed by bringing the' -edges 
together with fine horse-hair. 

7. The internal plastic work having been completed, the 
work of closing the external defect was begun. A transverse 
incision was first made across the anterior aspect of the neck 
one and one- half inches below the symphysis of the jaw. This 
incision was through the skin and subcutaneous tissues, down to 
the platysma. 

8. Skin between the lower edge of defect and this incision 
was dissected loose from underlying tissue to form a flap 
attached on both sides. 

9. Flap now "slid" upward over chin, completely filling 
defect. Retained in place by means of sutures of medium sized 
cat gut buried, attaching subcutaneous tissue of flap to perios- 
teum of body of jaw. An extra suture placed to produce the 
normal depression above the symphysis. 

10. Upper edge of flap sutured to free edge of mucous mem- 
brane by means of fine horse-hair. 

11. The "corners" formed ateach angle of defect where flap 
was brought up were now closed with fine silk- worm gut. 

11.'. Below the transverse incision in neck a second trans- 
verse incision, one and one-half inches long, was made through 
skin and subcutaneous tissue. 

13. Transverse incision closed with silk-worm gjt. 

14. Lower transverse incision closed vertically with silk- 
worm gut sutures. 

15. Dressing. 

Patient went on to an uneventful recovery, leaving hospital 
weeks after the operation. (Above steps of operation]^were 
kindly written up by Dr. Neff.) 



ALUMNI NOTES. 

'87. C. W. Oviatt, Oshkosh, Wis., writes that the Plexus 
is a welcomed visitor at his office. 

'87. F. A. Hanson, died of pulmonary tuberculosis, in 
January, at his home in Abrahams, Wis. He leaves a wife and 
two children. 

'88. D. Baldwin Wylie is located in Milwaukee. The doctor 
limits his practice to diseases of the eye and ear, and holds the 
chair of opthamology and otology in the Milwaukee Medical 
College. 

'88. W. F. Malone holds the chair of gynecology in the 
Milwaukee Medical College. The doctor is one of the busiest 
men in that thriving "suburb" of our city. 

'95. S. B. Clark is located at Buffalo, N. Dak. 

'94. A. B. Pickel is at Medford Oregon. 

'84. J. H. Bird is located at 90 Maiden Lane, N. Y. City. 

'95. Jos. C. Beck was married to Miss Carrie Stein, of 
Chicago, on March 26th. The Plexus extends congratulations. 

'97. C. W. Virtue is located at Akron, Ohio. The doctor 
sends his year's subscription to the Plexus. He makes the 
timely suggestion to the senior class that after choosing a 
location they shall call on every reputable physician in the 
locality as an act of courtesy which is due the older doctor and 
in this way to find out who will antagonize him in his new field. 

'99. W. J. Klein is located at 1002 Wellington Ave., Chi- 
cago. The doctor has been appointed on the staff of St. 
Anthony's Hospital. 

'99. Thurston Smith and C. E. Sisson have both been 
appointed assistant surgeons in the U. S. Army. Smith has 
been ordered to the Philippines but Sisson has married him a 
wife and therefore he cannot go. 

'99. C. M. Coen, has moved from Mendota, 111., to Maroa, 
Illinois. 



SENIOR NOTES. 

Rock had been quizzed. 

Dryden thought digestion was somewhat slower but not so 
rapid and we understand most authorities agree with him on the 
point. 



356 Tlie Plexus. 

Flippin's latest:— Inflammations are divided into two classes, 
inflammatory, and noninflammatory. 

The symptoms were multitudinous and manifold. 

To be popular, you must have the mumps. No quicker way 
to get "swell'". 

In a recent clinic the class was treated to an exhibition of 
tumbling that was well worth seeing. The Dr. should be pro- 
moted to the position of athletic director. 

The D. J's. were vanquished, but at the expense of Thomp- 
son's coat and Meridian's dignity. Thompson has a new one. 

Both Mrs. Elliot and the Junior blushed, but, My! It was so 
sudden. 

"Arkansas" was disappointed that he didn't see his friend, 
but got some valuable experience. 

227 pounds of carrots a total waste. What are we coming to? 

Kirk recently had some difficulty in maintaining his identity 
but finally succeeded in squaring himself. 

Again Hurst comes forward with an original proposition. 
This time it is, "Inguinal Appendicitis". 

C. F. Osborne is in the West side hospital with typhoid. 
The class extends sympathy and hopes for a speedy recovery. 

We take pleasure even at this late date in announcing the 
fact that within the last few months "Boolging" and Kerrigan 
have each attained to the state of fatherhood. We congratulate 
not even suggesting that we all can smoke if its any accom- 
modation. 

The green or the yellow':' Which? Rah, for Monahan and 
Ireland et al. 



JUNIOR NOTES, 



Dr. Newman advises the use of duck pants in gynecological 
operations. Certain members of the class (namely the hens) 
object. We do not know whether it is the wood duck that they 
object to or whether they would prefer to wear rainy day skirts. 

Van made a good attempt to convince Dr. Davis that the 
back part of the mouth and the posterior nares were synon- 
ymous terms but he made a failure of it. We can only surmise 
what will happen when Dr. Murphy and Van meet next year. 



Jiiitior Notes. 357 

Dr. G. U. Taylor, our assistant orthopedic surgeon, has 
fallen heir to another title, e. g. "Idio/'If you have occasion to 
wonder why, just ask him about it. 

Dr. Q. Burgman seems to be quite busy with his practice or 
else his office and lecture hours conflict somewhat, as he usually 
reaches the upper row of seats at about the second half. His 
appearance is usually the sign of a chorus of Quack! Quack! 
Quack. 

Burgman says that the reason that the boys don't like him 
is because he knows so much more than they do. 

Miss Willing seems to have a forlorn hope of a recon- 
sideration and we hope that she will not again be turned down. 

The junior class held their annual election of officers on 
Thursday the twenty-third, it all went along YQvy nicely. The 
main feature of same being the brilliant oration of Mr. Lampe. 
We regret very much that his ability is not more ap^Dreciated by 
his associates than it is, but, perhaps his fond hopes will be 
realized next year, at least we hope so for his sake. Robertson 
was nominated for the office of secretary but he promptly refused 
the office for which we are very sorry as he would have made a 
good officer. Mr. Robertson has the honor of being the only 
man to decline. 

The officers elected were as follows: 

W. D. McDowell, President. 

Zack J. Little, Vice President. 

Francis J. Buss, Secretary. 

Joseph Zaboketsky, Treasurer. 

Charles W. Burt, Editor. 

The tellers appointed by President Howard are as follows: 

W. B. Martin, T. H. Rolfs, H. S. Leonard, W. M. Newnan, 
E. W. Burke. 

The selection of all of the tellers from the McDowell faction 
and more from the Holenberg faction could, perhaps, have been 
a little fairer than it was, but I presume that we must submit. 

We will soon bid each other a fond farewell and proceed to 
pack our various little trunks, valises, telescopes and band boxes 
then hie ourselves in a homeward direction. But there will 
undoubtedly remain in the minds of many of us, a few fond 
memories of our Junior year and a sincere wish that the various 



358 The Plexus. 

little "roasts'' of your editor may be pardoned and that we may 
all meet at the P. & S. as seniors in 1901. 

Our classmate, Von Weidlestadt, had the misfortune of 
losing his father on Monday. 

Ask Urquhart to tell you the story of the lima bean mystery. 



SOPHOMORE NOTES. 

Bartholemew ventured into D. J. class the other day, expect- 
ing to fiDd them a body of gentlemen, as all D. J. classes have 
been heretofore (?). "Bart" doesn't known just how he got out, 
it took the whole class to do it any how. 

Drs. Agnew, Morris and Bothne are particularly fond of 
Italian opera. When the street waifs were performing in the 
court three necks were stretched from the fourth floor window. 
"Shake'er up thei^e little gal," says Agnew by way of applause* 
Then Morris throws down a lead nickle and calls for the skirt 
dance while Bothne does the clapping act— but suddenly three 
buckets of water from above are hurled on those three heads and 
the scene ends. Ask Agnew for the rest. 

Hamilton and Moffet of the Senior class, and "Doc" Johnson 
of the Sophomore class are the three crack carrom players in col 1 ege 
No deciding match having been played, it is difficult to say who 
is the best of the three, yet odds are in favor of Johnson. He is 
a scientific player and can see a good thing a long way off. 
Newman, Hyde and Ty vant may be put in class two, while Pudge 
Rhodefeld, Coates and J. S. Brown come third. Newman says 
one of the first class would be a good player, if he could hit the 
broad side of a barn, but being a junior, we class him in the sec- 
ond class. 

While J. D. Garrett was ill with fever he was constantly 
calling for "Emily." Sometimes he pretended to be writing as 
if a note, and again seem to be reading one. Will some one diagnose 
this case. 

The soriee of the female frat. was a most enjoyable alfair. 
Miss Day being hostess no more need be said as to the entertain- 
ment and accessories to the same. "We had a delightful time.'' 
said the girls — "of course there were no boys present," and at 
the same time expressions of sadness stole over their countenances. 

Stillman says it took merecourags to accompany Leavitt and 



Freshmen Holes. 359 

the two girls into L. A. than dodge bullets in the Philippines. 
Leavitt, too. looked somewhat out of place; but never mind, 
boys, practice makes perfect; one of these days you will come in 
with as much no7ichalance as a Tolly. 

Had it not not been for Potter's knife Rosy, Tolly and Potter 
would have tried walking home from the down town region. 
But the knife saved them. 



FRESHMEN NOTES. 
"Burdens of beast" and "compound Irish mixture" only show 
that professors are liable to make a misstep in speech. 

President Barnum had the sympathy of the entire class while 
carrying his voice in a sling. "Dad" Holmes, however, made a 
very professional appearing substitute, especially after the fire 
sale. 

' Dr. Eckley was evidently astonished and somewhat amused 
to hear during a recitation that the planiform abdominal muscles 
were for the purpose of expelling the organs of the abdomen. 

Expressions of regret at the passing of the chemical labora- 
tory are about as few as the proverbial hen's teeth. Everyone 
seems glad that the agony is over — for this year at least. There 
is no lack of compliments for both our geniel professor and his 
able assistants, who have endeared themselves to the class by 
their apparent efforts to lighten our hours of grief. 
We are only D. J's. you know 

And what we say then must be so; 
" For by the leary public wayside means 
We have not yet at all been seen. 

So believe — 
The brainy, wisey, soph's, they tried to vSleigh, 

But still we held the wits at bay. 
The whizzing of the driver's whip a'nigh — 
Oh brains! the smartness linger high. 

Around the neck — 
The slaying Doc's, from below strayed past A A. 

Their whiskers for to show the D. J's. 
We Flipp em up and Hurst and all — 

They came, we saw, we conquered Gaul. 

Ragtime-Taylor's. 



360 The Plexus. 

The faiut odor of a horse liniment, bearing an aroma not 
soon to be forgotten, remains monumental of an accident to one 
of this class some weeks ago. It was during the recent frequentcy 
of midnight obstetrical cases that Paul R. Urmston, awak- 
ened from dreams of Ohio and its agricultural greatness, hustled 
into his clothes and soon established himself in a high dry seat 
of the C. A. to take note of the proceedings. Owing to some 
mistake upon the part of nature the case failed to come off and 
our obstetrician was obliged to return to his abode. On the way 
down stairs, said Paul became entangled with one of his feet, 
when the dust cleared it was discovered he had sustained a 
sprained ankle. For days he did not put in an appearance and 
when he did there was an array of crutches, combined with the 
penetrating odor of Cactus Oil or some other horse liniment. As 
a class we appreciate the sprain also the crutches but we cer- 
tainly must ask to be spared from the further association of that 
liniment. 



THE MOUTH AND CHIN OF WOMAN AS AN 
INDEX OF CHARACTER. 

According to the Uiforma medica for September 14th, Dr. 
Weingarter is of the opinion that a woman's character can be 
completely known from a study of her mouth and chin. A round 
chin, downy on the fissure, betrays little force of will, love of 
pleasure and frivolity, and is typical of a kind, affectionate, 
polite, good-hearted woman, but extravagant, whimsical, and 
capricious. When the chin is small and mobile, and slightly 
projecting, it is the sign of a strong will. Such a chin marks a 
woman of more imagination than heart, desirous of excelling, 
with a mixture of sentiment and practical sense, with jealousy 
added. The mouth small, with the lips moderately full, the 
upper lij:) slightly projecting, is distinctive of a cold heart, sus- 
piciousne.s, but little sentiment, a calm and reflective tempera- 
ment, pride, ambition, and egoism. A mouth of proper pro- 
portions he considers to denote the exact opposite. The Riforma 
medica suggests this subject as a new field for research. Will 
the lady doctors give us some points on the character of men 
from similar observations':' — N. Y. Med. Journal. 




W. M. HAKSHA, A. B., M. D. 

Professor of Operative and Clinical Surgery, College of 
Physicians and Surgeons, Chicago. 



THE PLEXUS 

THE OFFICIAL ORGAN OF 

THE COLLEGE OF PHYSICIANS AND SURGEONS 

MEDICAL DEPARTMENT Of THE 

UNIVERSITY OF ILLINOIS, 

VOL. VI. MAY 20th, -1900. NO. 1. 

NOTES ON SURGICAL DIAGNOSIS. 

Wm. M. Harsha, A. B., M. D., Professor of Operative aad Clinical Sui-g-ery, 
College of Physicians and Surgeons, Chicago. 

Since modern methods enable the surgeon to explore every 
part of the human body, all possible means of discovering various 
surgical lesions are made necessary. A potent reason for one 
man doing more surgery than another is the fact that he is pre- 
pared to find the diseases. I am aware that there is a class of 
surgeons who have formulae for arriving at diagnoses and recom- 
mending operation. On this plan, a man will only need to learn 
that the patient is uncomfortable, that he has pain, has lost flesh 
or that he is disabled. No cause being apparent, the diagnosis is 
a "reflex trouble"' and an operation on some favorite organ is ad- 
vised, usually one most diflicult for the patient to examine. If 
the surgeon leans to gynesology, it is the pelvic organs in 
women; if he is an orificial surgeon it is usually the rectum in 
either sex. But these suggestions are intended for men of scien- 
tific bent and training, of honest purjjose and legitimate endeavor. 
The man who aspires to do the best in surgery, as in medicine, 
must avail himself of all that is known. If to this he can add his 
mite as he pursues his professional career, so much the better. 
In sociology men are roughly divided into three classes: First, 
those whose lives and influence tend to retrogression; second, 
those who maintain the status quo; and third, those who are more 



•2 The Plexus. 

aggressive and by reason of greater ability or more energy and 
industry, advance the state of civilization. We may apply the 
same classification to professional life. If the student in or out 
of college keeps before him a fixed purpose, to advance himself 
and the profession he practices, it is worth more to him than all 
the lore he may have stored away in his brain. Other things be- 
ing equal, that man who has the most well-directed ambition 
when he graduates will ca.iry furthest in his professional career. 
It is for such as he that there is always room. It is the unskilled 
labor of every kind that is a drug on the market. 

In many cases that jDresent themselves to the surgeon, it is 
apparent at a glance what the trouble is. In others, all the 
means at our command will not suffice for a positive diagnosis; 
but the better and more systematic the investigation the fewer 
the cases that escape our search. In a paper like this, one can 
only touch upon the subject in various places leaving unmen- 
tioned the great bulk of the study that is common practice. A 
systematic investigation requires the keeping of case records. 
The scheme does not need to be elaborate, but should serve to 
remind the surgeon of every part of the human organism — that 
no guilty organ may escape. It is a distinct advantage in many 
surgical cases to accompany the completed record with a diagram, 
for which blanks are made, showing location and extent of dis 
ease. Important points in records are name, address, nationality, 
age, sex, occupation, family history, personal history, habits, 
former disease or injury, etc. The early symptoms are of much 
importance. Many a case of empyema has been overlooked by 
reason of neglect to inquire into the start of the disease; and the 
origin of tumors may be determined by the history of their devel- 
opment. The statement of the patient should first be heard and 
not shut off as of no consequence. Approximately 25 per cent of 
sarcomata originate from injury. Abscess of the liver is not 
confined to the tropics, but in many cases is preceded by attacks 
of dysentery or gall-stones. Abscess of the brain may exist for a 
long time, or occur a considerable period after an injury to the 
head. Before a man can expect to be a good diagnostician, he 
must be well-versed in the natural history of the disease, its eti- 
ology an